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

doi:10.1002/jor.25339

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

J Orthop Res. 2023 Jan;41(1):54-62. doi: 10.1002/jor.25339. Epub 2022 Apr 13.

Authors

Amanda M Westman¹, Hexia Guo^{2

3}, Yameng Xu⁴, Wubin Bai⁵, Yiming Liu^{2

3}, Wei Ouyang³, William Moritz¹, Lauren Jacobson¹, Yang Weng², Hao Zang², Changsheng Wu³, Ziying Hu³, Shuo Li³, Di Lu³, Hany M Arafa^{3

6}, Matthew R MacEwan⁴, Lauren Tatman⁷, John A Rogers^{2

3

6

8

9

10

11}, Mitchell A Pet¹

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA.
² Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois, USA.
³ Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA.
⁴ Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri, USA.
⁵ Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁶ Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA.
⁷ Division of Trauma Surgery, Department of Orthopaedic Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA.
⁸ Department of Chemistry, Northwestern University, Evanston, Illinois, USA.
⁹ Department of Mechanical Engineering, Northwestern University, Evanston, Illinois, USA.
¹⁰ Department of Electrical and Computer Engineering, Northwestern University, Evanston, Illinois, USA.
¹¹ Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.

PMID: 35384025
DOI: 10.1002/jor.25339

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.

Keywords: compartment syndrome; intramuscular; near-infrared spectroscopy; perfusion monitoring.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Compartment Syndromes* / diagnosis
Muscles
Spectroscopy, Near-Infrared*
Swine