Percutaneously introduced wireless intramuscular near-infrared spectroscopy device detects muscle oxygenation changes in porcine model of lower extremity compartment syndrome

Amanda M. Westman, Hexia Guo, Yameng Xu, Wubin Bai, Yiming Liu, Wei Ouyang, William Moritz, Lauren Jacobson, Yang Weng, Hao Zang, Changsheng Wu, Ziying Hu, Shuo Li, Di Lu, Hany M. Arafa, Matthew R. MacEwan, Lauren Tatman, John A. Rogers*, Mitchell A. Pet*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Serial examination and direct measurement of intracompartmental pressure (ICP) are suboptimal strategies for the detection of acute compartment syndrome (CS) because they are operator-dependent and yield information that only indirectly reflects intracompartmental muscle perfusion. As a result, instances of unnecessary fasciotomy and unrecognized CS are relatively common. Recently, near-infrared spectroscopy (NIRS)-based systems for compartment monitoring have generated interest as an adjunct tool. Under ideal conditions, NIRS directly measures the oxygenation of intracompartmental muscle (StO2), thereby obviating the challenges of interpreting equivocal clinical examination or ICP data. Despite these potential advantages, existing NIRS sensors are plagued by technical difficulties that limit clinical utility. Most of these limitations relate to their transcutaneous design that makes them susceptible to both interference from intervening skin/subcutaneous tissue, underlying hematoma, and instability of the skin-sensor interface. Here, we present a flexible, wireless, Bluetooth-enabled, percutaneously introducible intramuscular NIRS device that directly and continuously measures the StO2 of intracompartmental muscle. Proof of concept for this device is demonstrated in a swine lower extremity balloon compression model of acute CS, wherein we simultaneously track muscle oxygenation, ICP, and compartment perfusion pressure (PP). The observed StO2 decreased with increasing ICP and decreasing PP and then recovered following pressure reduction. The mean change in StO2 as the PP was decreased from baseline to 30 mmHg was −7.6%. The mean difference between baseline and nadir StO2 was −17.4%. Cross-correlations (absolute value) describing the correspondence between StO2 and ICP were >0.73. This novel intramuscular NIRS device identifies decreased muscle perfusion in the setting of evolving CS.

Original languageEnglish (US)
Pages (from-to)54-62
Number of pages9
JournalJournal of Orthopaedic Research
Volume41
Issue number1
DOIs
StatePublished - Jan 2023

Funding

Dr. Pet, Dr. MacEwan, and Dr. Rogers have a patent “Novel Wireless Probes for Tissue Perfusion Monitoring” pending. Matthew MacEwan, MD, PhD, holds an equity position in Acera Surgical, Inc. and OsteoVantage, Inc., is a board member at Acera Surgical, Inc. and has received funding from ConductiveBio, Inc. Mitchell A. Pet, MD, has received research funding from Checkpoint Inc. Aside from the issues disclosed above, no authors have any actual or potential conflicts of interest related to the study matter. All authors have read and approved the final submitted manuscript. Funding for this study was received from the Division of Plastic Surgery and the Department of Neurosurgery at Washington University and from the Querrey Simpson Institute of Bioelectronics at Northwestern University.

Keywords

  • compartment syndrome
  • intramuscular
  • near-infrared spectroscopy
  • perfusion monitoring

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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