Optimizing the Use of Sentinel Skin Paddle in Monitoring Buried Fasciocutaneous Free Flaps

Rubino, Corrado; Farace, Francesco; Fara, Giorgia; Dessena, Lidia; Faenza, Mario

doi:10.1097/prs.0b013e31820635a1

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…For several days postoperatively, the blood flow can be monitored by opening the clamp and measuring venous outflow 58 . There are a plethora of other publications regarding the use of various externalised monitoring tissues 16,23,49,[60][61][62][63][64][65] .…”

Section: Resultsmentioning

confidence: 99%

The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part II: Clinical application

Molitor¹,

Měšťák²,

Pink³

et al. 2021

BIOMED PAP

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Despite the high success rate of micro-vascular flaps, anastomosis compromise occurs in 5-10% and that can lead to flap failure. Reliable monitoring of the flap is therefore of similar importance to that of the precise surgical procedure itself. Multiple methods have been reported for monitoring of the flap vitality, the first one being direct visual monitoring. In buried flaps direct visualisation is not feasible or is unreliable. In these cases we can extend the buried flap to expose a segment of it to act as a monitoring sentinel. For the purpose of this review we used our clinical experience as a starting point, and for the extended information and expertise we conducted a search of the PubMed database. Over 40 monitoring techniques have been reported to-date. Direct visual monitoring is still generally used method with a reliability of up to 100% and an overall success rate of up to 99%. Direct visualisation remains as the simplest, cheapest and yet a very reliable method of flap monitoring. In this review we provide a description of various possible techniques for externalising part of a buried flap, define the tissues that can be used for this purpose and we summarise the procedures that should be followed to achieve the best reliability and validity of monitoring the skin island.

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Section: Resultsmentioning

confidence: 99%

The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part II: Clinical application

Molitor¹,

Měšťák²,

Pink³

et al. 2021

BIOMED PAP

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“…This problem was first recognized in head and neck reconstruction where completely buried flaps are common and the effects of a potential flap failure more detrimental. Consequently, the idea of externalizing a skin paddle for the sole purpose of flap monitoring, which could then be excised at a second stage, was developed for jejunal and fasciocutaneous flaps used in pharyngeal and laryngeal reconstruction [ 27 - 29 ].…”

Section: Discussionmentioning

confidence: 99%

An Algorithm for Selecting Buoy Skin Paddle Design for Flap Monitoring in Total Autologous Breast Reconstruction After Nipple-Sparing Mastectomy

Samaras¹,

Malata²

2023

Cureus

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IntroductionMonitoring buried flaps in reconstructive breast surgery is challenging, and the ideal technique is controversial. Established options include leaving an exterior ("buoy" or "sentinel") skin paddle versus invasive implantable devices to avoid removing the paddle later. Technical modifications and an algorithm for strategic skin paddle positioning to circumvent this while avoiding complex monitoring equipment are proposed. Patients and methodsPatients in whom buoy skin paddles were utilized for breast flap monitoring by a single surgeon were reviewed. Indications, demographic details, precise monitoring paddle location, and flap outcomes were evaluated. An algorithm and classification system were then formulated. ResultsThirteen buoy skin paddles were utilized in seven patients (mean age: 43.5 years; range: 31-65) to monitor reconstructive flaps performed for risk-reducing mastectomies (four patients and seven breasts), therapeutic mastectomy (one breast), and revision surgery (three patients and five breasts). The flaps comprised seven deep inferior epigastric artery perforators (DIEPs), four superficial inferior epigastric arteries (SIEAs), and two pedicled latissimus dorsi (LDs) (mean free flap weight: 809 g; average mastectomy weight (n = 10 breasts): 467 g; range: 248-864). The skin paddles were located horizontally along the inframammary crease or vertically inferior to the nipple-areola or both. All flap transfers were successful with no re-explorations. All patients declined the monitoring paddle excision, and none have requested breast mound revision for poor cosmesis or contour deformities. ConclusionVertical and horizontal skin paddles proved reliable for buried flap monitoring without recourse to invasive and expensive equipment. When designed appropriately, they do not require revision surgery. An algorithmic classification of skin paddle location to enable this is proposed.

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“…Insbesondere bei der Brustrekonstruktion wird dieses Verfahren angewendet. Alternativ sind auch hier apparative Möglichkeiten, wie die Dopplersonde möglich[14,15].Monitoring der Lappenplastik -KonsensusDas regelhafte Monitoring der Lappenplastik wurde mit breiter Mehrheit konsentiert. In den ersten 48 Stunden sollte eine stünd liche klinische Kontrolle der Lappenplastik erfolgen.…”

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Perioperatives Management in der Mikrochirurgie – Konsensus-Statement der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße

Wallner

Kolbenschlag

Daigeler

et al. 2020

Handchir Mikrochir Plast Chir

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ZusammenfassungDas perioperative Management in der Mikrochirurgie ist ein wesentlicher Bestandteil einer erfolgreichen rekonstruktiven Chirurgie. Im deutschsprachigen Raum herrschen hierzu keine einheitlichen Konzepte und die individuellen Schemata unterscheiden sich wie in der Expertenbefragung erhoben deutlich voneinander. Im Zuge der 41. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM) im November 2019 in München wurden Konzepte evaluiert, eine Befragung durchgeführt und mithilfe einer Literaturrecherche als Positionspapier zusammengefasst.

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Optimizing the Use of Sentinel Skin Paddle in Monitoring Buried Fasciocutaneous Free Flaps

Cited by 4 publications

References 2 publications

The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part II: Clinical application

The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part II: Clinical application

An Algorithm for Selecting Buoy Skin Paddle Design for Flap Monitoring in Total Autologous Breast Reconstruction After Nipple-Sparing Mastectomy

Perioperatives Management in der Mikrochirurgie – Konsensus-Statement der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße

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