Measurement of blood flow and oxygen tension in adjacent tissues in pedicled and free flap head and neck reconstruction

Abstract

The purpose of this study was to evaluate blood flow and transcutaneous partial oxygen pressure (TcPO(2)) in adjacent tissues to free and pedicled flaps following reconstructive procedures used in conjunction with radical surgery for head and neck cancers. Fifty patients were included. Fourteen patients had reconstruction with pedicled flaps and 36 with free flaps. For each patient, TcPO(2) and laser Doppler flow measurements were taken at the center of the flap, in adjacent tissue, and in a corresponding contralateral site. Three laser Doppler measurements were performed at each site and a mean value recorded. All patients had undergone reconstruction up to 6 months prior to the time of the measurements. The collected data were analyzed using a Wilcoxon signed rank test. There were no statistically significant differences in partial oxygen tension or laser Doppler values between tissues adjacent to free compared to pedicled flaps. Although there is strong evidence to support that free flaps have improved blood flow and partial oxygen tension over pedicled flaps, further study is required to evaluate adjacent tissues. Flap choice may assist with alteration in blood flow in less favorable defects such as those in previously irradiated fields and those resulting from burn scars or chronic infections.

A comparison of skin and muscle for cortical revascularization

“…Free muscle deve-lops blood flow equivalent to or greater than pedicled muscle (38). A number of recent studies have compared the blood supply to pedicled and free muscle flaps and their ability to increase oxygen tension in adjacent tissues (22,38). Although significant differences were not demonstrated in oxygen tension nor laser doppler flow in adjacent skin (22), there is strong evidence to support higher blood flow to muscle raised as a free rather than pedicle flap in the transverse rectus abdominis (TRAM) flap used for human breast reconstruction (38).…”

“…A number of recent studies have compared the blood supply to pedicled and free muscle flaps and their ability to increase oxygen tension in adjacent tissues (22,38). Although significant differences were not demonstrated in oxygen tension nor laser doppler flow in adjacent skin (22), there is strong evidence to support higher blood flow to muscle raised as a free rather than pedicle flap in the transverse rectus abdominis (TRAM) flap used for human breast reconstruction (38). Blood flow to the free trapezi- us muscle flap, and hence to underlying bone, may be higher than levels predicted by studies of local pedicled muscle (1,37).…”

Metastatic implantation of oral cancer in forearm: An unusual presentation

“…The first choice for repair of large head-and-neck defects is free microvascular tissue transfer. Although results from pedicled flaps such as the pectoralis major have been good, free flaps provide a vibrant blood supply, allowing for more aggressive contouring and better wound coverage [4,5]. The incidence of the development of SCC in post-operative, post-traumatic, or chronic wounds is well recognized, but implantation of metastatic SCC in a free flap donor site is very rare.…”

Microsurgical free flap in head and neck reconstruction

“…9,10 Today, microsurgical free flap is the accepted standard of care for head and neck reconstruction after tumor extirpation. [11][12][13][14] Flap selection, techniques, and outcomes of free tissue transfer have continuously been improved and refined with experience gained in the past decades. This review provides an update on the state of the art in head and neck microsurgical free flaps.…”