Purpose
Timely and accurate triage of upper extremity injuries is critical, but current perfusion
monitoring technologies have shortcomings. These limitations are especially pronounced
in patients with darker skin tones. This pilot study evaluates a Eulerian Video Magnification
(EVM) algorithm combined with color channel waveform extraction to enable video-based
measurement of hand and finger perfusion.
Methods
Videos of 10 volunteer study participants with Fitzpatrick skin types III–VI were
taken in a controlled environment during normal perfusion and tourniquet-induced ischemia.
Videos were EVM processed, and red/green/blue color channel characteristics were extracted
to produce waveforms. These videos were assessed by surgeons with a range of expertise
in hand injuries. The videos were randomized and presented in 1 of 3 ways: unprocessed,
EVM processed, and EVM with waveform output (EVM+waveform). Survey respondents indicated
whether the video showed an ischemic or perfused hand or if they were unable to tell.
We used group comparisons to evaluate response accuracy across video types, skin tones,
and respondent groups.
Results
Of the 51 providers to whom the surveys were sent, 25 (49%) completed them. Using
the Pearson χ2 test, the frequencies of correct responses were significantly higher in the EVM+waveform
category than in the unprocessed or EVM videos. Additionally, the agreement was higher
among responses to the EVM+waveform questions than among responses to the unprocessed
or EVM processed. The accuracy and agreement from the EVM+waveform group were consistent
across all skin pigmentations evaluated.
Conclusions
Video-based EVM processing combined with waveform extraction from color channels improved
the surgeon’s ability to identify tourniquet-induced finger ischemia via video across
all skin types tested.
Clinical relevance
Eulerian Video Magnification with waveform extraction improved the assessment of perfusion
in the distal upper extremity and has potential future applications, including triage,
postsurgery vascular assessment, and telemedicine.
Key words
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References
- Patterns of vascular anastomoses vs. success of free groin flap transfers.Plast Reconstr Surg. 1979; 64: 37-40
- Current evidence for postoperative monitoring of microvascular free flaps: a systematic review.Ann Plast Surg. 2015; 74: 621-632
- Treatment of the severely injured upper extremity.Instr Course Lect. 2000; 49: 377-396
- Annual hospital volume and success of digital replantation.Plast Reconstr Surg. 2017; 139: 672-680
- The detrimental effect of decentralization in digital replantation in the United States: 15 years of evidence from the national inpatient sample.J Hand Surg Am. 2016; 41: 593-601
- The effect of skin pigmentation on determination of limb ischemia.J Hand Surg Am. 2018; 43: 24-32.e1
- Racial differences in ischemic complications of pedicled versus free abdominal flaps for breast reconstruction.Ann Plast Surg. 2014; 72: S172-S175
- Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases.Plast Reconstr Surg. 1999; 104: 97-101
- Postoperative monitoring of free flaps in autologous breast reconstruction: a multicenter comparison of 398 flaps using clinical monitoring, microdialysis, and the implantable Doppler probe.J Reconstr Microsurg. 2010; 26: 409-416
- A new diagnostic algorithm for early prediction of vascular compromise in 208 microsurgical flaps using tissue oxygen saturation measurements.Ann Plast Surg. 2009; 62: 538-543
- A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry.J Reconstr Microsurg. 2013; 29: 51-56
- Near infrared spectroscopy for monitoring flap viability following breast reconstruction.J Reconstr Microsurg. 2012; 28: 149-154
- The role of duplex ultrasound in microsurgical reconstruction: review and technical considerations.J Reconstr Microsurg. 2020; 36: 514-521
- The use of pulse oximetry for objective quantification of vascular injuries in the hand.Plast Reconstr Surg. 2015; 136: 1227-1233
- Racial bias in pulse oximetry measurement.N Engl J Med. 2020; 383: 2477-2478
- Effects of skin pigmentation on pulse oximeter accuracy at low saturation.Anesthesiology. 2005; 102: 715-719
- The use of visible light spectroscopy to measure tissue oxygenation in free flap reconstruction.J Reconstr Microsurg. 2011; 27: 397-402
Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. Mar 2007;28(3):R1–R39.
- The effect of spectral photoplethysmography amplification and its application in dynamic spectrum for effective noninvasive detection of blood components.Opt Laser Technol. 2021; 133106515
- Eulerian Video Magnification for revealing subtle changes in the world.ACM Trans Graph. 2012; 31: 1-8
- Skin type classification systems old and new.Dermatol Clin. 2009; 27 (viii): 529-533
- The validity and practicality of sun-reactive skin types I through VI.Arch Dermatol. 1988; 124: 869-871
- Clinical Dermatology. 4th. Blackwell Publishing, 2008
- Völker, Rassen, Sprachen.Welt-Verlag, 1922
- Scar treatment variations by skin type.Facial Plast Surg Clin North Am. 2014; 22: 453-462
- A coefficient of agreement for nominal scales.Educ Psychol Meas. 1960; 20: 37-46
- Correlation between skin color evaluation by skin color scale chart and narrowband reflectance spectrophotometer.Indian J Dermatol. 2014; 59: 339-342
- Detection of perfusion disturbances in digit replantation using near-infrared spectroscopy and serial quantitative fluoroscopy.J Hand Surg Am. 2006; 31: 456-462
- Adipose tissue thickness affects in vivo quantitative near-IR spectroscopy in human skeletal muscle.Clin Sci (Lond). 2001; 101: 21-28
- Understanding near-infrared spectroscopy.Adv Neonatal Care. 2011; 11: 382-388
- Comparison of pulse oximetry and handheld Doppler for assessing digital perfusion.Bull Hosp Jt Dis (2013). 2019; 77: 128-131
- Hand Telemedicine Program, UAMS Physician Save Batesville Man’s Hand. 2015.https://news.uams.edu/2015/05/11/hand-telemedicine-program-uams-physician-save-batesville-mans-hand-2/Date accessed: March 1, 2019
- Replantation versus revision of amputated fingers in patients air-transported to a level 1 trauma center.J Hand Surg Am. 2010; 35: 936-940
- Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis.J Trauma. 2006; 60 (discussion 1265–1266): 1257-1265
- The cost of overtriage: more than one-third of low-risk injured patients were taken to major trauma centers.Health Aff (Millwood). 2013; 32: 1591-1599
- Noninvasive free flap monitoring using Eulerian Video Magnification.Case Rep Otolaryngol. 2016; 20169471696
Yuan H, Zhang X, Wang J, Liu N, Shi X. Detection of limb ischemia based on Eulerian Video Magnification. Paper presented at: Optics in Health Care and Biomedical Optics VIII; October 11-13; 2018; Beijing, China.
- Video Magnification Techniques: Medical Applications and Comparison of Methods. IOP Conference Series: Materials Science and Engineering. IOP Publishing Ltd, 2021
Article info
Publication history
Published online: August 10, 2022
Accepted:
June 22,
2022
Received:
January 11,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
