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Open Access
CC BY 4.0 · Arch Plast Surg 2026; 53(01): 091-101
DOI: 10.1055/a-2660-4344
Reconstruction/Lymphedema
Review Article

Next-Generation Flap Monitoring: Systematic Review and Meta-Analysis of Hyperspectral Imaging

Authors

  • Parintosa Atmodiwirjo 

    1   Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

  • Cristabella Rininta 

    1   Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
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Abstract

Early detection of perfusion deficits is crucial for optimal flap outcomes. Hyperspectral imaging (HSI) offers a non-invasive method to assess tissue perfusion, potentially detecting complications earlier than Doppler ultrasound or near-infrared spectroscopy. This systematic review and meta-analysis evaluate the efficacy and diagnostic accuracy of HSI in monitoring flap viability, particularly in detecting ischemia and necrosis. A systematic search of PubMed, ScienceDirect, and Cochrane Library was conducted following PRISMA 2020 guidelines. Studies on HSI's role in flap viability were critically appraised using the Critical Appraisal Skills Programme checklist. A random-effects model was applied for the meta-analysis. Nine studies were included, six focusing on flap complications. HSI demonstrated a median sensitivity of 93% (63–100%) and a median specificity of 96% (81–100%) for detecting compromised flaps, outperforming clinical assessments in some cases. Significant differences were observed between viable and necrotic tissues in four key HSI parameters: Oxygen saturation, tissue hemoglobin index (THI), tissue water index, and near-infrared perfusion index (NIR-PI). THI and NIR-PI effectively differentiated venous congestion from arterial occlusion. However, heterogeneity across the studies indicated a need for standardized protocols. Notably, HSI detected perfusion deficits up to 4.8 hours before clinical signs. HSI shows promise for postoperative flap monitoring, enabling earlier detection of ischemia and necrosis. Future research should focus on standardized imaging protocols, real-time analysis, and larger multicenter trials to confirm HSI's clinical utility and cost-effectiveness.

Keywords

hyperspectral imaging - flap monitoring - flap viability - systematic review and meta-analysis

Authors' Contributions

Conceptualization: all authors.


Data curation: all authors.


Formal analysis: all authors.


Methodology: all authors.


Visualization: all authors.


Writing—original draft: all authors.


Writing—re-view and editing: all authors.


Approval of final manuscript: all authors.


Ethical Approval

The study was performed in accordance with the principles of the Declaration of Helsinki.


Patient Consent

Not applicable.




Publication History

Received: 24 February 2025

Accepted: 17 July 2025

Article published online:
30 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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