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Studies on Polarised Light Spectroscopy
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis project focuses on measurements of dermal microcirculation during vascular provocations with polarised light spectroscopy. This is done with a non-invasive method commercially available as Tissue viability imaging (TiVi) which measures concentration and oxygenation of red blood cells in the papillary dermis. Three studies were done with human subjects and one with an animal model, to validate and compare the TiVi technique with laser Doppler flowmetry, which is an established method of measuring dermal microcirculation.

The TiVi consists of a digital camera with polarisation filters in front of the flash and lens, with software for analysis of the picture. When taking a picture with the TiVi, the polarised light that is reflected on the skin surface is absorbed by the second filter over the lens (which is perpendicular to the first filter) but a portion of light penetrates the surface of the skin and is scattered when it is reflected on tissue components. This makes the light depolarised, passes the second filter, and produces a picture for analysis. The red blood cell (RBC) has a distinct absorption pattern that differs between red and green colour compared to melanin and other components of tissue. This difference is used by the software that calculates differences in each picture element and produces a measure of output which is proportional to the concentration of red blood cells. The oxygenation of RBC can also be calculated, as there is a difference in absorption depending on oxygen state.

The first paper takes up possible sources of error such as ambient light, and the angle and distance of the camera. The main experiment was to investigate how the local heating reaction is detected with TiVi compared to LDF.

In the second paper arterial and venous stasis are examined in healthy subjects with TiVi.

The Third paper is an animal study where skin flaps were raised on pigs, and the vascular pedicle is isolated to enable control of inflow and outflow of blood.The measurements were made during partial venous, total venous, and total arterial occlusion. The TiVi recorded changes in the concentration of RBC, oxygenation and heterogeneity and the results were compared with those of laser Doppler flowmetry.

In the fourth paper oxygenation and deoxygenation of RBC: s was studied. Studies were made on the forearms of healthy subjects who were exposed to arterial and venous occlusion. Simultaneous measurements were made with TiVi and Enhanced perfusion and oxygen saturation or EPOS, which is a new device that combines laser Doppler flowmetry and diffuse reflectance spectroscopy in one probe.

With TiVi, one can measure RBC concentration and oxygenation in the area of an entire picture or in one or multiple user defined regions of interest (ROI). Methods such as laser Doppler flowmetry makes single point measurements, which is a potential source of error both because of the heterogeneity of the microcirculation, and that the circulation be insufficient in the margins of the investigated area. TiVi has been able to measure venous stasis more accurately than laser Doppler flowmetry, and venous stasis is the more common reason for flaps to fail.

The TiVi is an accurate way to measure the concentration of RBC and trends in oxygenation of the dermal microcirculation. It has interesting possible applications for microvascular and dermatological research, monitoring of flaps, and diagnosis of peripheral vascular disease. Future clinical studies are needed as well as development of the user interface.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 48
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1689
National Category
Medical Laboratory and Measurements Technologies
Identifiers
URN: urn:nbn:se:liu:diva-159084DOI: 10.3384/diss.diva-159084ISBN: 9789176850428 (print)OAI: oai:DiVA.org:liu-159084DiVA, id: diva2:1338638
Public defence
2019-09-02, Belladonnasalen, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2019-07-23 Created: 2019-07-23 Last updated: 2019-09-18Bibliographically approved
List of papers
1. Polarized Light Spectroscopy for Measurement of the Microvascular Response to Local Heating at Multiple Skin Sites
Open this publication in new window or tab >>Polarized Light Spectroscopy for Measurement of the Microvascular Response to Local Heating at Multiple Skin Sites
2012 (English)In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 19, no 8, p. 705-713Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate whether TiVi, a technique based on polarized light, could measure the change in RBC concentration during local heating in healthy volunteers. Methods: Using a custom-made transparent heater, forearm skin was heated to 42 degrees C for 40 minutes while the change in RBC concentration was measured with TiVi. The perfusion response during local heating was measured at the same time with Laser Doppler flowmetry. Results: Mean RBC concentration increased (91 +/- 34 vs. 51 +/- 34 A.U. at baseline, p less than 0.001). The spatial heterogeneity of the RBC concentration in the measured skin areas was 26 +/- 6.4% at baseline, and 23 +/- 4.6% after 40 minutes of heating. The mean RBC concentrations in two skin sites were highly correlated (0.98 at baseline and 0.96 after 40 minutes of heating). The change in RBC concentration was less than the change in perfusion, measured with LDF. Unlike with LDF, a neurally mediated peak was not observed with TiVi in most of the test subjects. Conclusions: TiVi is a valuable technique for measuring the microvascular response to local heating in the skin, and offers a high reproducibility for simultaneous measurements at different skin sites, provided carefully controlled experiments are ensured.

Place, publisher, year, edition, pages
Informa Healthcare / John Wiley and Sons, 2012
Keywords
tissue viability imaging; polarization light spectroscopy; local heating; red blood cell concentration; reproducibility
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87225 (URN)10.1111/j.1549-8719.2012.00203.x (DOI)000311373400004 ()
Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2019-07-23
2. Assessment of microcirculation of the skin using Tissue Viability Imaging: A promising technique for detecting venous stasis in the skin
Open this publication in new window or tab >>Assessment of microcirculation of the skin using Tissue Viability Imaging: A promising technique for detecting venous stasis in the skin
Show others...
2015 (English)In: Microvascular Research, ISSN 0026-2862, E-ISSN 1095-9319, Vol. 101, p. 20-25Article in journal (Refereed) Published
Abstract [en]

Background: : Venous occlusion in the skin is difficult to detect by existing measurement techniques. Our aim was to find out whether Tissue Viability Imaging (TiVi) was better at detecting venous occlusion by comparing it with results of laser Doppler flowmetry (LDF) during graded arterial and venous stasis in human forearm skin. Methods: : Arterial and venous occlusions were simulated in 10 healthy volunteers by inflating a blood pressure cuff around the upper right arm. Changes in the concentration of red blood cells (RBC) were measured using TiVi, while skin perfusion and concentration of moving red blood cells (CMBC) were measured using static indices of LDF during exsanguination and subsequent arterial occlusion, postocclusive reactive hyperaemia, and graded increasing and decreasing venous stasis. Results: : During arterial occlusion there was a significant reduction in the mean concentration of RBC from baseline, as well as in perfusion and CMBC (p less than 0.008). Venous occlusion resulted in a significant 28% increase in the concentration of RBC (p = 0.002), but no significant change in perfusion (mean change -14%) while CMBC decreased significantly by 24% (p = 0.02). With stepwise increasing occlusion pressures there was a significant rise in the TiVi index and reduction in perfusion (p = 0.008), while the reverse was seen when venous flow was gradually restored. Conclusion: : The concentration of RBC measured with TiVi changes rapidly and consistently during both total and partial arterial and venous occlusions, while the changes in perfusion, measured by LDF, were less consistent This suggests that TiVi could be a more useful, non-invasive clinical monitoring tool for detecting venous stasis in the skin than LDF.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Tissue viability imaging; Laser Doppler flowmetry; Post-occusive hyperaemia; Venous occlusion; Arterial occlusion
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121302 (URN)10.1016/j.mvr.2015.06.002 (DOI)000360028500004 ()26092681 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden [2014JZ0004]

Available from: 2015-09-16 Created: 2015-09-14 Last updated: 2019-07-23Bibliographically approved
3. Vascular Occlusion in a Porcine Flap Model: Effects on Blood Cell Concentration and Oxygenation.
Open this publication in new window or tab >>Vascular Occlusion in a Porcine Flap Model: Effects on Blood Cell Concentration and Oxygenation.
Show others...
2017 (English)In: Plastic and reconstructive surgery. Global open, ISSN 2169-7574, Vol. 5, no 11, article id e1531Article in journal (Refereed) Published
Abstract [en]

Background: Venous congestion in skin flaps is difficult to detect. This study evaluated the ability of tissue viability imaging (TiVi) to measure changes in the concentration of red blood cells (CRBC), oxygenation, and heterogeneity during vascular provocations in a porcine fasciocutaneous flap model.

Methods: In 5 pigs, cranial gluteal artery perforator flaps were raised (8 flaps in 5 pigs). The arterial and venous blood flow was monitored with ultrasonic flow probes. CRBC, tissue oxygenation, and heterogeneity in the skin were monitored with TiVi during baseline, 50% and 100% venous occlusion, recovery, 100% arterial occlusion and final recovery, thereby simulating venous and arterial occlusion of a free fasciocutaneous flap. A laser Doppler probe was used as a reference for microvascular perfusion in the flap.

Results: During partial and complete venous occlusion, increases in CRBC were seen in different regions of the flap. They were more pronounced in the distal part. During complete arterial occlusion, CRBC decreased in all but the most distal parts of the flap. There were also increases in tissue oxygenation and heterogeneity during venous occlusion.

Conclusions: TiVi measures regional changes in CRBC in the skin of the flap during arterial and venous occlusion, as well as an increase in oxygenated hemoglobin during venous occlusion that may be the result of reduced metabolism and impaired delivery of oxygen to the tissue. TiVi may provide a promising method for measuring flap viability because it is hand-held, easy to-use, and provides spatial information on venous congestion.

Place, publisher, year, edition, pages
Wolters Kluwer, 2017
National Category
Radiology, Nuclear Medicine and Medical Imaging Surgery
Identifiers
urn:nbn:se:liu:diva-145391 (URN)10.1097/GOX.0000000000001531 (DOI)29263951 (PubMedID)2-s2.0-85038559789 (Scopus ID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2019-07-23Bibliographically approved

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