Improved Salvage of Complicated Microvascular Transplants Monitored with Quantitative Fluorometry

Whitney, Timothy M.; Lineaweaver, William C.; Billys, James B.; Siko, Peter P.; Buncke, Gregory M.; Alpert, Bernard S.; Oliva, Alfonso; Buncke, Harry J.; Maurois, André

doi:10.1097/00006534-199207000-00016

Cited by 35 publications

(22 citation statements)

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“…The second was the false-positive rate, which was calculated as all flaps with positive monitoring alarms that were found to have no pedicle compromise (i.e., false positives) divided by all flaps with no pedicle compromise (i.e., all false positives and all true negatives). These have been described previously as true tests of the efficacy of each technique by Whitney et al 9 and Lineaweaver, 21 with flap salvage rate showing the benefit of any monitoring technique in improving outcomes and the false-positive rate reporting the number of needless returns to theater. Both of these measures are aimed at demonstrating the effectiveness of the monitoring technique when compared with no monitoring at all (or a nonfunctioning monitor, a concept that is also of Lineaweaver's invention 21 ).…”

Section: Algorithm and Outcome Analysismentioning

confidence: 97%

“…[1][2][3][4][5][6] Currently, the only method that is ubiquitous amongst microsurgical units is the use of clinical monitoring. 7,8 Although some studies have demonstrated that adjunctive monitoring techniques may have benefit, and indeed that flap salvage rate may be increased, [9][10][11] there are still no large-scale comparative trials supporting these studies. Without reasonable evidence for new monitoring techniques, bedside monitoring has remained the norm, with some units using adjunctive techniques at the discretion of the surgeon.…”

mentioning

confidence: 99%

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The efficacy of postoperative monitoring: A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps

et al. 2009

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Section: Algorithm and Outcome Analysismentioning

confidence: 97%

mentioning

confidence: 99%

The efficacy of postoperative monitoring: A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps

et al. 2009

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“…When the distal target vessel could not be further debrided and if there were still concerns about vessel quality, heparin was added. Skin islands were monitored by physical exam, fluorometry, 8 and surface Doppler confirming perfusion from day 1 through day 5 postoperatively.…”

Section: Methodsmentioning

confidence: 99%

Use of the venous flap for salvage of difficult ring avulsion injuries

2008

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Ring avulsion can lead to soft tissue compromise resulting in eventual digit failure or restriction of motion. The authors present use of the venous flow through flap for simultaneous soft tissue and digital vessel reconstruction in severe ring avulsion injury. A retrospective review of ring avulsion injuries treated with transplantation of an arterialized (A-V-A) venous flap between 1999 and 2006 was conducted. Indications included digits which were debrided and required soft tissue and digital artery reconstruction. Eight venous flaps were transplanted for 3 Urbaniak class II and 5 Urbaniak class III ring avulsions. Average size of the venous flap was 6 cm(2). All flaps and digits survived without partial necrosis. The soft tissue envelope was supple in all cases. Total active motion (TAM) ranged from 160 to 210 degrees. The arterialized venous flow-through flap is a reliable solution for the complex ring avulsion injury which requires simultaneous soft tissue and digital vessel reconstruction.

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“…3,4 Monitoring circulation of microsurgical flaps has been repeatedly examined for efficacy in early detection of vascular complications in the hope that prompt detection and treatment of such complications can avoid the tissue degeneration due to prolonged secondary ischemia and reperfusion cycles leading to flap death. [5][6][7] Thus far, no single method of flap circulation monitoring has been described as reliable and ideal. The most commonly used method of monitoring has been mere clinical examination, which employs observation of tissue color, capillary refill, and bleeding tests.…”

Section: Microsurgery 17:306-312 1996mentioning

confidence: 99%

Magnetic resonance imaging detection of vascular occlusion of a pedicled muscle flap

et al. 1996

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Contrast-enhanced magnetic resonance imaging (MRI) can be a highly sensitive monitor of tissue blood perfusion. This technique has been used to assess blood flow through liver, kidney, and certain tumors, but has not been widely applied to the study of skeletal muscle circulation. In our study, we used a novel scanning software to obtain contrast-enhanced T2*-weighted gradient echo MRI images of pedicled quadriceps muscle flaps in rabbits in order to study images of arterial, venous, and arterio-venous occlusion. We administered an intravenous bolus of gadoteridol contrast agent at the initiation of scanning, which produces a decrease in T2*-signal and improves the sensitivity of measuring blood perfusion. Within 30 seconds of MRI scanning, control flaps with intact pedicles exhibited a rapid decrease in T2*-signal intensity, indicating adequate perfusion of blood through muscle tissue; however, occluded pedicled flaps showed no significant change in signal intensity, indicating lack of blood perfusion. Differences in signal intensities as measured by MRI between occluded and control flaps were statistically significant (P < 0.05). Selective vascular occlusion of either artery alone, or both artery and vein were detected within 15 minutes, whereas selective venous occlusion could be detected after 2 hours. We conclude that MRI has the ability to assess skeletal muscle perfusion, and is capable of noninvasively evaluating a cross-section of tissue in both superficial and buried flaps. MRI, therefore, may have the potential for evaluating perfusion in muscle flaps (including buried flaps), and other disorders of muscle circulation such as compartment syndrome.

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Improved Salvage of Complicated Microvascular Transplants Monitored with Quantitative Fluorometry

Cited by 35 publications

References 0 publications

The efficacy of postoperative monitoring: A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps

The efficacy of postoperative monitoring: A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps

Use of the venous flap for salvage of difficult ring avulsion injuries

Magnetic resonance imaging detection of vascular occlusion of a pedicled muscle flap

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