ASK THE EXPERT: DR. MARTIN JOHNSON
ASK THE EXPERT
Dr. Martin L. Johnson is a plastic surgeon who was in private practice in Phoenix/Scottsdale for 30 years and was involved with multiple hospitals in the area, including Mayo Clinic-Phoenix. Currently, Dr. Johnson is at Casa Colina Hospital and Centers for Healing in Pomona, CA leading a limb preservation clinic with a focus on amputation prevention and wound healing. He received his medical degree from Baylor College of Medicine.
What type of patients do you find the use of SnapshotNIR to be the most beneficial?
As a plastic surgeon with a wound care focus, there are three areas that I think it is most helpful.
From a plastic surgery perspective, we do several kinds of flap surgeries. These can be as simple as a forehead flap to reconstruct the nose or a complex reconstruction for cancer, specifically the breast. This is where I see the greatest benefit. Typically, for a patient who is having a mastectomy, a great deal of the skin is lifted from the underlying breast. To minimize dehiscence, we must ensure there is adequate perfusion and oxygen in the flap. Identification of flap viability helps limit complications and additional surgeries. If you are using an implant, you want to make sure that it is adequately covered. When using a free tissue transfer (DIEP flap), you don’t want to de-epithelialize tissue if you are using that skin from the lower abdomen to assist with the reconstruction of the breast. Also, breast reduction and mastopexy are two areas in plastic surgery that require adequate oxygen saturation in the tissues such as the nipple-areola complex and flaps.
An area in wound care where NIRS imaging has been helpful is in identifying the success of a debridement. We take Snapshot images pre- and post-debridement and frequently see a very robust increase in tissue oxygen saturation in the area that was debrided. It is also beneficial when using advanced therapies, such as cellular and tissue-based products (CTPs) or synthetic skin substitutes, in conjunction with the debridements to ensure a well-prepared wound bed and peri-wound that will support the successful integration of the product. Ongoing imaging helps track and assess healing.
And finally, in the wound space, the Snapshot device has been very beneficial with hyperbaric oxygen therapy. We’ve had instances where we can identify when somebody will benefit from hyperbaric therapy or when a patient may not. We can visualize when and where tissue oxygenation is inadequate and then follow the patients through their treatment period. If their oxygen saturation is not rising, there is little benefit to continuing with hyperbarics. The objective data allows us to determine the best time and place to utilize that treatment. Within minutes you can have an answer versus waiting for a transcutaneous oximetry (TCOM) test that takes an hour and requires a warm room. Snapshot allows you to follow the patient easily through treatment.
We’re looking at possibly initiating the device in the in-patient rehabilitation space to assess patients - using it in conjunction with other technologies and identifying if someone could be at risk for developing a pressure injury. Wound care nurses I have worked with are considering its use to assess patients on the floor to determine if they are at high risk for these injuries. I think that would be a huge benefit.
Where is the tissue viability insight the most beneficial in surgical interventions? You mentioned breast flaps earlier.
Yes, breast flaps. The information obtained from the Snapshot device can be particularly useful with breast reductions and mastopexies to assess tissue oxygenation in flaps, particularly the nipple-areola complex. We are always concerned about viability in these tissues. If you can identify in a matter of minutes whether the individual has adequate tissue oxygen saturation or may benefit from an additional intervention, it’s significant.
How does SnapshotNIR instill confidence as to when to move forward or what the next steps are?
In flap surgeries, it’s huge. When looking at dusky appearing tissue, your decision can be influenced based on the interpretation of the Snapshot images.
I had a 95-year-old patient with a trans-metatarsal amputation and the dorsal flap was very dark. Based on the tissue oxygenation saturation we assessed that he may benefit from hyperbaric treatments. We followed his hyperbaric oxygen treatment program with Snapshot images, and he successfully healed his wound and saved his foot. At his age and state of health, additional surgery would have been debilitating.
How do you find that SnapshotNIR supports cost efficiencies in your practice?
This technology saves time and time is money. If you have a patient who has a questionable flap, Snapshot allows you to identify if there is adequate tissue oxygen saturation for viability. There are times when we can identify that hyperbaric oxygen therapy is not required, thus eliminating the need for a patient to be in a chamber 2-3 hours a day, in addition to saving the facility nearly $1,000 a day. There are some procedures in plastic surgery that insurance may not cover so you have both the expense and the lost time. When I think about cost efficiencies, I’m thinking for not only the patient but for the practice as well.
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