Enhancing Hand Vascular Assessment: The Role of Hyperspectral Imaging in Perfusion Monitoring

Purpose: Accurate assessment and monitoring of tissue perfusion are critical in diagnosing and managing vascular diseases of the hand. Traditional methods, including clinical examination, pulse oximetry, and Doppler ultrasound, have limitations in detecting early or subtle perfusion deficits. Hyperspectral imaging (HSI) is a noninvasive, real-time technology that generates quantitative perfusion maps by measuring oxygen saturation, oxyhemoglobin, and deoxyhemoglobin levels. To the best of our knowledge, this is the first study of its kind to evaluate the clinical use of HSI in assessing perfusion abnormalities in vascular conditions of the hand and its emerging applications in hand surgery. Methods: A single center study was conducted from 2021 to 2025, involving 5 patients with various upper-extremity vascular conditions, each followed to early 2025. Perfusion images were obtained using the HyperView (HyperMed, Memphis, TN) system before and after surgical or procedural interventions. Results were compared against the contralateral hand or historical normal values from the prior-generation HyperView (OxyVu-1) system. Results: Hyperspectral imaging effectively identified perfusion deficits, guided urgent clinical decision-making, and monitored postoperative improvements. In one case, HSI demonstrated a 5% increase in tissue oxygen saturation after ulnar artery reconstruction, correlating with successful wound healing. Another patient with Raynaud's phenomenon showed a 23% perfusion increase following botulinum toxin injection. Hyperspectral imaging also detected thrombosis and monitored perioperative oxygen saturation changes in real-time. Conclusions: Hyperspectral imaging offers a novel, objective approach to perfusion assessment in hand and upper-extremity vascular disease, addressing key limitations of traditional methods. Its integration into clinical workflows holds promise for enhancing real-time, data-driven decision-making in hand surgery and vascular medicine. Type of Study/level of evidence: Diagnostic IV.