Glucose level evaluation in monopedicled rectus abdominis myocutaneous flap after venous occlusion: experimental study in rats

Berlim, Gustavo Levacov; Oliveira, Antonio Carlos Pinto; Portinho, Ciro Paz; Morello, Emerson Rogerio; Linhares, Carolina Barbi; Collares, Marcus Vinícius Martins

doi:10.1590/0100-6991e-20181276

Cited by 2 publications

(4 citation statements)

References 29 publications

(45 reference statements)

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“…To clarify the diagnostic criteria of flap congestion with high specificity and sensitivity, several new indexes have been created, including the rate of decline of systemic glucose and the differences between systemic and interstitial glucose levels. 14,19 However, the systemic glucose of diabetic rats in the present study was found to fluctuate during anesthesia, surgery, and monitoring. Therefore, unstable systemic glucose cannot be included as a diagnostic criterion.…”

Section: Discussioncontrasting

confidence: 52%

“…The present results showed that the interstitial glucose of the flaps in nondiabetic rats consistently decreased to the lowest level at 56.5 minutes, which is comparable to previous studies. 14,21,23 However, in diabetic rats, the time taken for the interstitial glucose to decrease to its lowest level was doubled to 120.8 minutes. A possible explanation is that diabetes impairs cellular glucose metabolism and microcirculation in flaps.…”

Section: Discussionmentioning

confidence: 99%

“…To achieve higher specificity and sensitivity, the alert threshold for re-exploration was calculated based not only on the changes in the flap glucose level itself, but also on the discrepancy between the flap glucose and systemic glucose, as well as the ratio of the flap glucose changes. 14,19,24 However, these previous studies were all conducted in normoglycemic animals and patients rather than diabetic individuals.…”

mentioning

confidence: 99%

“…Based on this phenomenon, other studies subsequently confirmed and expanded these results to clinical monitoring. [13][14][15][16][17][18][19][20][21][22][23][24] The evidence demonstrates that flap glucose measurement is a diagnostically valid method to detect flap venous occlusion. Furthermore, Sitzman et al 23 used the continuous interstitial glucose monitor (CIGM) as a more convenient way of detecting flap interstitial glucose levels.…”

mentioning

confidence: 99%

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Continuous Interstitial Glucose Measurement for Flap Venous Occlusion Monitoring in a Diabetic Model

Zhang

Wang

et al. 2022

Journal of Craniofacial Surgery

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Glucose has been used in the monitoring of transplanted flaps. However, few studies have focused on the effect of diabetes on the decrease in flap glucose levels. The purpose of this study was to evaluate the application of continuous interstitial glucose monitoring to detect flap venous occlusion in a diabetic rat model. The flap interstitial glucose level was measured by transcutaneous sensors in the bilateral vertical rectus abdominis myocutaneous flaps of each rat. interstitial glucose values in the bilateral flaps were recorded every 5 minutes after the venous occlusion of 1 flap. Forty-one rats were divided into the control group (n = 13), diabetic group (n = 15, established by the intraperitoneal injection of streptozotocin), and insulintreated diabetic group (n = 13, systemic glucose well controlled by insulin before surgery). Results indicated that flap interstitial glucose decreased to the lowest level in all flaps with venous occlusion. The time from venous occlusionto the lowest interstitial glucose level was significantlylongerinthe diabetic group than the control group (120.8 ± 5.7 minutes versus 56.5 ± 6.7 min-minutes, P < 0.001), but was similar in the insulintreated diabetic and control groups (56.5 ± 6.7 minutes versus 56.0 ± 6.6 minutes, P = 0.876). The change in interstitial glucose in both the diabetic and insulin-treated diabetic groups began with a plateau period or a slow decline before decreasing for 49.0 ± 6.4 minutes and 24.4 ± 4.3 min-minutes, respectively. in a diabetic rat model, impaired glucose metabolism prolongs the required monitoring time and dulls the reaction of flap interstitial glucose to venous congestion. Insulin restores the prolonged monitoring time, but not the reaction of flap interstitial glucose. Therefore, care is needed during application of the technique in diabetic patients.

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Section: Discussioncontrasting

confidence: 52%