Glucose and Lactate Metabolism in Well-Perfused and Compromised Microvascular Flaps

Setälä, Leena; Gudavičienė, Daiva

doi:10.1055/s-0033-1348039

Cited by 13 publications

(9 citation statements)

References 10 publications

(22 reference statements)

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“…The largest study conducted by Setala and Gudaviciene17 had 268 flaps, followed by Setälä et al13 (109 flaps) and Nielsen (2010) (78 flaps). The studies with the smallest sample sizes were Udensen (2000) (16 flaps) followed by Frost (2015) (22 flaps).…”

Section: Resultsmentioning

confidence: 99%

“…In the 13 included studies [8][9][10][11][12][13][14][15][16][17][18][19][20] published between 2000 and 2019, 841 flaps were analyzed. The distribution of the flap number, flap type, substances measured, and parameters of detection in those studies is presented in Supplemental Table 1 (Supplemental Digital Content 1, http://links.lww.com/SCS/ E357).…”

Section: Summary Of Study Designsmentioning

confidence: 99%

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Diagnostic Accuracy of Microdialysis in Postoperative Flap Monitoring

Hwang¹

2022

Journal of Craniofacial Surgery

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Postoperative monitoring plays an important role in achieving success in microvascular free tissue transfer. A systematic review was designed to evaluate the clinical outcomes of microdialysis in flap monitoring and a meta-analysis was conducted for diagnostic accuracies. The search terms “microdialysis” and “flap” were used in a PubMed and Scopus search, resulting in 60 and 78 results, respectively. Among 78 titles, 15 articles were excluded. Among 63 abstracts, 43 abstracts were excluded. From 20 full texts, 7 articles were excluded because they did not have sufficient content (ie, the statistical values in question). A systematic review was conducted of the final 13 articles. The overall sensitivity was 97.24% [95% confidence interval (CI)=93.67%–99.10%]. Eleven of the 13 studies showed 100% sensitivity and 2 studies had 2 and 3 false negative results, resulting in sensitivity values of 85.8% and 95.3%. Specificity ranged from 91.89% to 100%, and the overall value was 98.15% (95% CI=96.80%–99.04%). The positive predictive value ranged from 84.62% to 100%, with an overall value of 93.62% (95% CI=89.33%–96.26%). The negative predictive value ranged from 94.44% to 100%, with an overall value of 99.22% (95% CI=98.17%–99.67%). The overall flap success rate (survival rate) was 93.7% (786/839). The lowest flap survival rate was 86.7% and the highest was 100%. Microdialysis provides excellent diagnostic accuracy and enables the early detection of ischemia in postoperative flap monitoring. Although microdialysis is not the most popular choice among surgeons, it should be considered adjacent to conventional clinical monitoring. Cost-effectiveness, availability, and ease of application remain hurdles.

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Section: Resultsmentioning

confidence: 99%

Section: Summary Of Study Designsmentioning

confidence: 99%

Diagnostic Accuracy of Microdialysis in Postoperative Flap Monitoring

Hwang¹

2022

Journal of Craniofacial Surgery

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“…Despite the fact that insulin levels are lower in peripheral tissues, such as the skin, our results indicate that it has an active local role in maintaining local metabolic homeostasis as well as having an effect on the local microcirculation. Previous studies using microdialysis in the skin, for example in burn patients 27 and in reconstructive surgery 28 , show local effects in the skin that may not be seen in the central circulation, suggesting an un-coupling effect between local tissue homeostasis and central vital functions. Therefore, a better understanding of the connection between local impaired glucose metabolism and ischemia is essential to finding ways to prevent morbidity, and the need for further surgery when the skin homeostasis is challenged.…”

Section: Discussionmentioning

confidence: 96%

Sampling insulin in different tissue compartments using microdialysis: methodological aspects

Högstedt

Ghafouri

Tesselaar

et al. 2020

Sci Rep

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Sampling the concentration of insulin in human skin using microdialysis is challenging because of low intracutaneous concentrations and low recovery, presumably due to adsorption of insulin to the microdialysis system. In this study, we aimed to (1) measure how the concentration of insulin varies in three different tissue compartments (intracutaneous, subcutaneous and intravenous) and (2) to study how much insulin is adsorbed to the microdialysis catheter membranes and tubing during a typical microdialysis experiment, both in vivo and in vitro. We hypothesized that (1) the concentration of insulin decreases from the intravenous compartment to the intracutaneous and subcutaneous tissue, and that (2) adsorption of insulin to the microdialysis membrane and tubing impairs the recovery of insulin from the tissue. In this experimental study, microdialysis catheters were inserted intracutaneously, subcutaneously and intravenously in 11 healthy subjects. Systemic endogenous hyperinsulinemia was induced by intake of an oral glucose load. Insulin concentration was measured in the dialysate and in the extracted samples from the catheter membrane and tubings. In vitro microdialysis was performed to investigate the temporal resolution of the adsorption. After an oral glucose load insulin concentration increased intravenously, but not in the intracutaneous or subcutaneous compartments, while glucose, lactate and pyruvate concentrations increased in all compartments. The adsorption of insulin to the microdialysis membrane in vivo was highest in the intravenous compartment (p = 0.01), compared to the intracutaneous and subcutaneous compartments. In vitro, the adsorption to the microdialysis membrane was highest one hour after sampling, then the concentration gradually decreased after three and five hours of sampling. The concentration of insulin in peripheral tissues is low, probably due to decreasing tissue vascularity. Adsorption of insulin to the microdialysis membrane is modest but time-dependent. This finding highlights the importance of a stabilization time for the microdialysis system before sampling tissue analytes.

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“…For patients with poorly controlled diabetes, capillary lactate values in flaps can also be used as a monitoring index in addition to the interstitial glucose level, as lactate significantly increases after flap perfusion failure. 11,18,20 A portable blood lactate analyzer is also available in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Monitoring based on instruments includes laser Doppler flowmetry, 5 transcutaneous oxygen tension, 6 color Doppler ultrasonography, 7 tissue pH, 8 and near-infrared spectroscopy. 9 Among these monitoring methods, microdialysis is highly sensitive to arterial ischemia and venous congestion through metabolic changes in flaps 10,11 however, as microdialysis involves high costs, a complicated operational procedure, and potential catheter displacement, the clinical application of this technique is limited. To simplify the microdialysis technique, flap local glucose measurement is considered a simple and practical method with low cost and easy access.…”

mentioning

confidence: 99%

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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Glucose and Lactate Metabolism in Well-Perfused and Compromised Microvascular Flaps

Cited by 13 publications

References 10 publications

Diagnostic Accuracy of Microdialysis in Postoperative Flap Monitoring

Diagnostic Accuracy of Microdialysis in Postoperative Flap Monitoring

Sampling insulin in different tissue compartments using microdialysis: methodological aspects

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

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