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Statistical Measurement of Quantitative Fluorescence Performance: 8760 Readings. Negative Tests Rule Out Circulatory Disturbances
Rudolf Buntic, MD, Bauback Safa, MD, Brian Parret, MD, Gregory Buncke, MD.
The Buncke Clinic, San Francisco, CA, USA.

AAPS Abstract
Statistical Measurement of Quantitative Fluorescence Performance: 8760 Readings. Negative Tests Rule Out Circulatory Disturbances
Purpose:
For 60 years, plastic surgeons have monitored perfusion with fluorescent dyes. Techniques have evolved from visual fluorescence using the Wood’s Lamp to Quantitative fluorescence using a specialized fluorometer as described by Walton in 1983. The purpose of this study is to precisely define the utility of quantitative fluorescence as a monitor in microsurgery using statistical measurements of performance.
Methods:
Patients admitted to our microsurgical service from March 2010 to August 2011 after digit replantation and cutaneous flap transplantation that required skin monitoring were enrolled. Fluorescence readings were assessed at bedside by nurses utilizing a quantitative fluorometer at baseline prior to injection, and at 10 minutes and 60 minutes after injection of fluorescein. Arterial and venous competyence were assessed based on a lack of rise or fall in standard fluroscein curves (Fig. 1). Adults were dosed with 1 ml of 10% fluorescein intravenously, pediatric patients with 1 mg/kg. Postoperativer fluorescein perfusion measurements were made every 2 hours for the first 24-48 hours and every 4 hour thereafter. Comparable sites were utilized as the control. Measurements were discontinued before discharge or when the clinician felt there was little chance of circulatory compromise.
Binary classification of test results was performed and sensitivity, specificity, positive and negative predictive values were calculated.
Results:
A total of 8760 quantitative fluorometry readings were performed in 77 patient, 8, replants 14 flaps and 7 ischemic parts.
In both arterial and venous phase testing, quantitative fluorescence showed a high sensitivity and specificity and 100% negative predictive value. The positive predictive value was 86%.
Statistical Measures of Quantitative Fluorometry
Sensitivity100%
Specificity99.47%
Positive Predictive Value Arterial and Venous86%
Negative Predictive Value100%
Positive Predictive Value Arterial Insufficiency93%
Positive Predictive Value Venous Insufficiency82%

Conclusions:
These results demonstrate that quantitative fluorometry is extremely sensitive, specific and has a high negative predictive value. No other perfusion detection method has been found to be as sensitive, specific and with such a certain predictive value.
Quantitative fluorometry is able to predict perfusion disturbances in skin. It has a high sensitivity, specificity and negative predictive value in the microsurgical patient population. . It acts as an early alert to the need for potential intervention. Quantitative Fluorometry is indicated for use in patients during circulatory or perfusion examinations of skin or when there is a suspicion of compromised circulation. It is safe, effective and reliable.
1.
Graham BH, Walton RL, Elings VB et. al. Surface Quantification of Injected Fluorescence as a Predictor of Flap Viability. Plast Recon Surg 71:826, 1983.
2.
Graham BH, Gord L, Alpert BS, et. al. Serial Quantitative Skin Surface Fluorescence: A New Method for Postoperative Monitoring of Vascular Perfusion in Revascularized Digits. J Hand Surg 10A:226, 1985.


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