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Photoplethysmography in post-operative monitoring of deep inferior epigastric perforator (DIEP) free flaps

Kyriacou, P. A. ORCID: 0000-0002-2868-485X, Zaman, T. & Pal, S. K. (2020). Photoplethysmography in post-operative monitoring of deep inferior epigastric perforator (DIEP) free flaps. Physiological Measurement, doi: 10.1088/1361-6579/abc4c8


INTRODUCTION: Deep Inferior Epigastric Perforator (DIEP) free flaps are widely used as a reconstruction option following mastectomy in breast cancer. During such cases partial tissue necrosis can occur due to the insufficient blood supply to the transplanted tissue site. Therefore, monitoring of flap perfusion and early detection of flap failure is a prerequisite to flap survival. There is a need to develop a non-invasive, easy to use, reproducible and inexpensive monitoring device to assess flap perfusion postoperatively.

METHOD: A three-wavelength reflective optical sensor and processing system based on the principle of photoplethysmography (PPG) has been developed to investigate blood volumetric changes and estimate free flap blood oxygen saturation continuously and non-invasively in Deep Inferior Epigastric Perforator (DIEP) free flaps in the postoperative period. The system was evaluated in fifteen patients undergoing breast reconstructive surgery using DIEP free flap.

RESULTS: Good quality red, infrared and green PPG signals were obtained in the post-operative period. Initial estimation of blood oxygen saturation values estimated from the free flap PPGs seem to be in broad agreement with the commercial finger pulse oximeter used in this study.

CONCLUSION: This pilot study has demonstrated that Photoplethysmography has the potential to be used as a monitoring technique in assessing free flap viability. REC Reference number: 10/H0703/39.

Publication Type: Article
Additional Information: This is the Accepted Manuscript version of an article accepted for publication in Physiological Measurement. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at
Subjects: R Medicine > RC Internal medicine
T Technology > TK Electrical engineering. Electronics Nuclear engineering
Departments: School of Science & Technology > Mathematics
Text - Accepted Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works 3.0.

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