A Novel Technology for Free Flap Monitoring: Pilot Study of a Wireless, Biodegradable Sensor

Biomechanical, Histologic, and Micro-Computed Tomography Characterization of Partial-Width Full-Thickness Supraspinatus Tendon Injury in Rats

PURPOSE

Partial rotator cuff tears can cause shoulder pain and dysfunction and are more common than complete tears. However, few studies examine partial injuries in small animals and, therefore a robust, clinically relevant model may be lacking. This study aimed to fully characterize the established rat model of partial rotator cuff injury over time and determine if it models human partial rotator cuff tears.

METHODS

We created a full-thickness, partial-width injury at the supraspinatus tendon-bone interface bilaterally in 31 Sprague-Dawley rats. Rats were euthanized immediately, and at 2-, 3-, 4-, and 8-weeks after surgery. Fourteen intact shoulders were used as controls. Samples were assessed biomechanically, histologically, and morphologically.

RESULTS

Biomechanically, load to failure in controls and 8 weeks after injury was significantly greater than immediately and 3 weeks after injury. Load to failure at 8 weeks was comparable to control. However, the locations of failure were different between intact shoulders and partially injured samples. Bone mineral density at 8 weeks was significantly greater than that at 2 and 3 weeks. Although no animals demonstrated propagation to complete tear and the injury site remodeled histologically, the appearance at 8 weeks was not identical to that in the controls.

CONCLUSIONS

The biomechanical properties and bone quality decreased after the injury and was restored gradually over time with full restoration by 8 weeks after injury. However, the findings were not equivalent to the intact shoulder. This study demonstrated the limitations of the current model in its application to long-term outcome studies, and the need for better models that can be used to assess chronic partial rotator cuff injuries.

CLINICAL RELEVANCE

There is no small animal model that mimics human chronic partial rotator cuff tears, which limits our ability to improve care for this common condition.

Post-surgical wireless monitoring of arterial health progression

Early detection of limb ischemia, strokes, and heart attacks may be enabled via long-term monitoring of arterial health. Early stenosis, decreased blood flow, and clots are common after surgical vascular bypass or plaque removal from a diseased vessel and can lead to the above diseases. Continuous arterial monitoring for the early diagnosis of such complications is possible by implanting a sensor during surgery that is wirelessly monitored by patients after surgery. Here, we report the design of a wireless capacitive sensor wrapped around the artery during surgery for continuous post-operative monitoring of arterial health. The sensor responds to diverse artery sizes and extents of occlusion in vitro to at least 20 cm upstream and downstream of the sensor. It demonstrated strong capability to monitor progression of arterial occlusion in human cadaver and small animal models. This technology is promising for wireless monitoring of arterial health for pre-symptomatic disease detection and prevention.

A Wireless Near-Infrared Spectroscopy Device for Flap Monitoring: Proof of Concept in a Porcine Musculocutaneous Flap Model

BACKGROUND

 Current near-infrared spectroscopy (NIRS)-based systems for continuous flap monitoring are highly sensitive for detecting malperfusion. However, the clinical utility and user experience are limited by the wired connection between the sensor and bedside console. This wire leads to instability of the flap-sensor interface and may cause false alarms.

METHODS

 We present a novel wearable wireless NIRS sensor for continuous fasciocutaneous free flap monitoring. This waterproof silicone-encapsulated Bluetooth-enabled device contains two light-emitting diodes and two photodetectors in addition to a battery sufficient for 5 days of uninterrupted function. This novel device was compared with a ViOptix T.Ox monitor in a porcine rectus abdominus myocutaneous flap model of arterial and venous occlusions.

RESULTS

 Devices were tested in four flaps using three animals. Both devices produced very similar tissue oxygen saturation (StO₂) tracings throughout the vascular clamping events, with obvious and parallel changes occurring on arterial clamping, arterial release, venous clamping, and venous release. Small interdevice variations in absolute StO₂ value readings and magnitude of change were observed. The normalized cross-correlation at zero lag describing correspondence between the novel NIRS and T.Ox devices was >0.99 in each trial.

CONCLUSION

 The wireless NIRS flap monitor is capable of detecting StO₂ changes resultant from arterial vascular occlusive events. In this porcine flap model, the functionality of this novel sensor closely mirrored that of the T.Ox wired platform. This device is waterproof, highly adhesive, skin conforming, and has sufficient battery life to function for 5 days. Clinical testing is necessary to determine if this wireless functionality translates into fewer false-positive alarms and a better user experience.

Developing a Wearable Sensor for Continuous Tissue Oxygenation Monitoring: A Proof of Concept Study

Objective Technologies facilitating continuous free tissue flap monitoring such as near infrared spectroscopy (NIRS) have been shown to improve flap salvage rates. However, the size and associated costs of such technology create a barrier to wider implementation. The aim of this study was to develop and validate a wearable sensor for continuous tissue oxygenation monitoring.

Materials and Methods A forearm ischemia model was designed by using a brachial pressure cuff inflation protocol. Twenty healthy subjects were recruited. The forearm tissue oxygenation of each subject was monitored throughout the pressure cuff protocol by using a new optical sensor (Imperial College London), and a gold standard tissue spectrometry system (O2C, Medizintecknik, LEA, Germany). Data were processed to allow quantitative deoxygenation episode comparisons between inflations and sensor modalities.

Results The correlation between O2C and optical sensor oxygenation measurements was moderate (average R = 0.672, p < 0.001). Incremental increases in cuff inflation duration resulted in a linear increase in deoxygenation values with both O2C and optical sensors, with significant differences recorded on consecutive inflations (wall shear rate, p < 0.005). The presence or absence of pulsatile blood flow was correctly determined throughout by both sensor modalities.

Conclusion This study demonstrates the ability of a small optical sensor to detect and quantify tissue oxygenation changes and assess the presence of pulsatile blood flow. Low power, miniaturized electronics make the device capable of deployment in a wearable form which may break down the barriers for implementation in postoperative flap monitoring.

A Review of Bioresorbable Implantable Medical Devices: Materials, Fabrication, and Implementation

Implantable medical devices (IMDs) are designed to sense specific parameters or stimulate organs and have been actively used for treatment and diagnosis of various diseases. IMDs are used for long-term disease screening or treatments and cannot be considered for short-term applications since patients need to go through a surgery for retrieval of the IMD. Advances in bioresorbable materials has led to the development of transient IMDs that can be resorbed by bodily fluids and disappear after a certain period. These devices are designed to be implanted in the adjacent of the targeted tissue for predetermined times with the aim of measurement of pressure, strain, or temperature, while the bioelectronic devices stimulate certain tissues. They enable opportunities for monitoring and treatment of acute diseases. To realize such transient and miniaturized devices, researchers utilize a variety of materials, novel fabrication methods, and device design strategies. This review discusses potential bioresorbable materials for each component in an IMD followed by programmable degradation and safety standards. Then, common fabrication methods for bioresorbable materials are introduced, along with challenges. The final section provides representative examples of bioresorbable IMDs for various applications with an emphasis on materials, device functionality, and fabrication methods.