Advancements in Free Flap Monitoring in the Last Decade: A Critical Review

Smit, Jeroen M.; Zeebregts, Clark J.; Acosta, Rafael; Werker, Paul M. N.

doi:10.1097/prs.0b013e3181c49580

Cited by 216 publications

(206 citation statements)

References 60 publications

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“…Currently, the most reliable method is the use of internal Doppler probes, which are placed beside the anastomosis and continuously measure the flow. [2][3][4][5][6][7][8][9][10][11][12][13]19 However, this method is not very popular in some countries such as Mexico because the cost of the device is unaffordable by most health institutions or by the patient. Direct thermography has been well established as a reliable monitoring method and is used in many hospitals worldwide due to its low cost and easy interpretation.…”

Section: Discussionmentioning

confidence: 99%

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Remote Monitoring of Perforator Flaps Using an Innovative Device with an Application for Mobile Phone: A Pilot Study

Parra

Montaño

2017

J Reconstr Microsurg Open

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Surgical technique is considered the most important determining factor in the success of the flap, resulting in an overall complication rate with flap loss risk < 1%. Another important aspect to maintain a high success rate is close monitoring of the flap to identify early variations of the inflow, allowing the possibility of early anastomosis revision surgery, resulting in a more favorable prognosis. 1Multiple methods for flap monitoring have been implemented over time; however, clinical judgment is still the most reliable method.2-8 Other methods used for monitoring perforator flaps are direct thermography, implantable Doppler, external Doppler, microdialysis, infrared oximetry flow, angiography, and images transmitted by electronic devices. These are but a few of the currently designed systems. 4,9-18The aim of this study is to report on a new device for temperature monitoring and its application for mobile telephones. Materials and Methods Design of the DeviceThe 15 Â 10 Â 5 cm device design is shown in ►Fig. 1. The blue liquid-crystal display (LCD) screen and the external characteristics are displayed. Input power transmitter and radiofrequency antenna signal can be observed. The device has an output for the temperature sensor through a 2-m long cable.This device works through a negative temperature coefficient medical grade sensor placed on the skin flap and Keywords ► perforator flaps ► remote monitoring ► mobile device AbstractBackground Surveillance and monitoring of perforator flaps has been well established for many years as a reliable method to detect early changes in the blood flow of the flap. In this manner, early flap revisions could be performed in cases of probable thrombosis. Methods We performed a pilot study that included the first 12 patients to use this device. A temperature sensor electrode was used for remote monitoring of perforator flaps using a mobile phone in real time via a general pocket radio service and short messages developed by the authors, allowing the surgeon to check the temperature from any location. Results The device continually displays the temperature of the flaps in real time performing a curve with measurements every 5 minute using the web page. A significant difference (p < 0.05) is shown between flaps with sufficient flow and flaps with venous thrombosis. Conclusion Real-time direct thermography via the surgeon's mobile phone is a reliable method for flap monitoring, facilitating monitorization during the time when the surgeon is away from the hospital.

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Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Other methods used for monitoring perforator flaps are direct thermography, implantable Doppler, external Doppler, microdialysis, infrared oximetry flow, angiography, and images transmitted by electronic devices. These are but a few of the currently designed systems.…”

mentioning

confidence: 99%

Remote Monitoring of Perforator Flaps Using an Innovative Device with an Application for Mobile Phone: A Pilot Study

Parra

Montaño

2017

J Reconstr Microsurg Open

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“…Many organs can be investigated with the LDF technique: kidney, liver, intestines, brain, skin. Moreover, the clinical applications are numerous: diabetes microangiopathy, flap monitoring, peripheral vascular disease, plastic surgery, Raynaud's phenomenon, thermal injury (see for example Ray et al, 1999;Humeau et al, 2004;Ziegler et al, 2004;Yamamoto-Suganuma & Aso, 2009;Merz et al, 2010;Smit et al, 2010). Due to the poor predictability of tissue perfusion for given location and time, LDF signals are rarely recorded in basal conditions.…”

Section: Introductionmentioning

confidence: 99%

Monte Carlo Methods to Numerically Simulate Signals Reflecting the Microvascular Perfusion

Figueiras¹,

Ferreira²,

Mul³

et al. 2011

Numerical Simulations - Applications, Examples and Theory

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“…Near infrared light is shone in tissues and light attenuations are then processed for the estimation of concentrations of oxygenated haemoglobin, reduced haemoglobin, total haemoglobin and tissue oxygenation (Pellicer anddel Carmen Bravo 2011, Scheeren et al 2012). NIRS-measured parameters have been demonstrated to monitor effectively perfusion changes in brain and muscle microcirculation in surgery, shock and trauma medicine, and reconstructive surgery (Smit et al 2010, Pellicer and del Carmen Bravo 2011, Scheeren et al 2012.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, in reconstructive surgery or trauma medicine, the prompt identification of local changes in perfusion and oxygenation can alert clinicians before arise of serious complications that may be undetected by global macrocirculation parameters or clinical observations (Lima and Bakker 2005, Smit et al 2010, Scheeren et al 2012. In this context, optical modalities such as near infrared spectroscopy (NIRS), laser Doppler flowmetry (LDF), photoplethysmography (PPG), and pulse oximetry (PO) have played a crucial role, due to their noninvasiveness, safe nature and their ability to provide local assessment of the microcirculation Bakker 2005, Sakr 2010).…”

Section: Introductionmentioning

confidence: 99%

Comparison of NIRS, laser Doppler flowmetry, photoplethysmography, and pulse oximetry during vascular occlusion challenges

Abay

Kyriacou

2016

Physiol. Meas.

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Monitoring changes in blood volume, blood flow, and oxygenation in tissues is of vital importance in fields such as reconstructive surgery and trauma medicine. Near infrared spectroscopy (NIRS), laser Doppler (LDF) flowmetry, photoplethysmography (PPG), and pulse oximetry (PO) contribute to such fields due to their safe and noninvasive nature. However, the techniques have been rarely investigated simultaneously or altogether. The aim of this study was to investigate all the techniques simultaneously on healthy subjects during vascular occlusion challenges. Sensors were attached on the forearm (NIRS and LDF) and fingers (PPG and PO) of 19 healthy volunteers. Different degrees of vascular occlusion were induced by inflating a pressure cuff on the upper arm. The responses of tissue oxygenation index (NIRS), tissue haemoglobin index (NIRS), flux (LDF), perfusion index (PPG), and arterial oxygen saturation (PO) have been recorded and analyzed. Moreover, the optical densities were calculated from slow varying dc PPG, in order to distinguish changes in venous blood volumes. The indexes showed significant changes ( p < 0.05) in almost all occlusions, either venous or over-systolic occlusions. However, differentiation between venous and arterial occlusion by LDF may be challenging and the perfusion index (PI) may not be adequate to indicate venous occlusions. Optical densities may be an additional tool to detect venous occlusions by PPG.

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Advancements in Free Flap Monitoring in the Last Decade: A Critical Review

Cited by 216 publications

References 60 publications

Remote Monitoring of Perforator Flaps Using an Innovative Device with an Application for Mobile Phone: A Pilot Study

Remote Monitoring of Perforator Flaps Using an Innovative Device with an Application for Mobile Phone: A Pilot Study

Monte Carlo Methods to Numerically Simulate Signals Reflecting the Microvascular Perfusion

Comparison of NIRS, laser Doppler flowmetry, photoplethysmography, and pulse oximetry during vascular occlusion challenges

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