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Eulerian Video Magnification for Flap Monitoring: Touch Free Perfusion Visualization
Stephen M. Lu, MD1, Armen K. Kasabian, MD1, Fan Liang, MD2.
1Northwell Health, Manhasset, NY, USA, 2University of Southern California, Los Angeles, CA, USA.

PURPOSE:
The gold standard for microsurgical free flap monitoring is clinical evaluation, frequently with the assistance of a pencil or surface Doppler device. However, such techniques depend largely on the skill and experience of the operator. Furthermore, while several technologies have been developed to monitor flap perfusion with varying degrees of sensitivity and specificity, they are frequently cumbersome, expensive, and invasive. Here we introduce a novel, digital video-based flap monitoring system that is non-invasive, operator independent, and economical as a way of evaluating flap perfusion.
METHODS:
Digital videos of rat abdominal fasciocutaneous flaps and human free flaps, finger replants, and perforator flaps were obtained and augmented using Eulerian Video Magnification (EVM) open source software provided by the Computer Science and Artificial Intelligence Laboratory at MIT.
RESULTS:
EVM applied to the flap videos resulted in an enhanced video clip which amplified subtle variations in perfusion and allowed users to "see" perfusion throughout the flap. Heart rate and perfusion quality were assessed in the videos and corroborated with clinical evaluation of flap health and physiology.
CONCLUSION:
Here we demonstrate proof of concept in both animal and human models that a novel non-invasive flap monitoring technology can reliably evaluate flap perfusion. The technology is free, sensitive, and simple to use. We anticipate that further development will result in an end-user device application (e.g., mobile app) which can evaluate flap viability in a safe, effective, and inexpensive fashion.


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