Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect

Abstract

Inclusion of continuous tissue oximetry in the postoperative monitoring protocol of microsurgical breast reconstruction is associated with significantly improved salvage rates and fewer flap losses. Furthermore, learning curve assessment demonstrates that use of tissue oximetry can decrease the rate of reexploration over time.

Outcomes of free flap reconstructions with near‐infrared spectroscopy (NIRS) monitoring: A systematic review

“…Two of the false‐positive detections coming from Takasu et al (), who used a NIRS detection parameter of an absolute drop of StO 2 by 20 points from baseline. The other false‐positive came from Koolen et al () using the detection parameters of StO 2 ≤ 30% or a drop in StO 2 > 20% per hour. In addition, Koolen et al () had one episode of a false‐negative in the NIRS monitoring group.…”

“…The other false‐positive came from Koolen et al () using the detection parameters of StO 2 ≤ 30% or a drop in StO 2 > 20% per hour. In addition, Koolen et al () had one episode of a false‐negative in the NIRS monitoring group. Overall sensitivity and specificity cannot be calculated with validity due to the heterogeneity between monitoring and reporting between studies.…”

“…Finally, there is a cost associated with adopting the NIRS technology. The cost of the disposable NIRS sensor ranges from $650 to 1,275 USD, and the reusable unit itself is an additional $19,500 to $30,000 (Koolen et al, ; Lohman et al, ; Pelletier et al, ; Repez et al, ). In comparison, the cost of an implantable Doppler probe is in the range of $400–500 USD for the disposable probe and $3500–5,000 USD for the reusable monitor (Lohman et al, ).…”

“…Although all studies reported the recognition of vascular compro- (Koolen et al, 2016;Lohman et al, 2012;Pelletier et al, 2011;Repez et al, 2008).…”

Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

“…Accurate and timely recognition of compromise enabled the flap salvage, which can increase the flap survival rate. Various adjunctive monitoring methodologies have been studied to facilitate more rapid and definite monitoring than clinical examinations, including implantable Doppler, tissue oximetry, microdialysis, and color duplex sonography . However, these approaches have several limitations, such as high cost, difficulty in performing the examination, and interexaminer variance; hence, they are not widely used .…”