Postoperative assessment of free skin flap viability by transcutaneous pO2 measurement using dynamic phosphorescence imaging

Geis, Sebastian; Schreml, Stephan; Lamby, Philipp; Obed, Aiman; Jung, Ernst Michael; Nerlich, Michael; Babilas, Philipp; Szeimies, R.–M.; Prantl, Lukas

doi:10.3233/ch-2009-1217

Cited by 13 publications

(18 citation statements)

References 23 publications

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“…The initial PubMed/MEDLINE/Cochrane search revealed 17 articles eligible for full-text review; of these, 6 were included in both the qualitative and quantitative analysis. [4][5][6][7][8][9] All studies included were prospective in nature (►Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements

Halani

Hembd

et al. 2022

Journal of Hand and Microsurgery

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Free tissue transfer is a cornerstone of complex reconstruction. In many cases, it represents the last option available for a patient and their reconstruction. At high-volume centers, the risk of free flap failure is low but its occurrence can be devastating. Currently, the mainstay for flap monitoring is the clinical examination. Though reliable when performed by experienced clinicians, the flap exam is largely subjective, is performed discontinuously, and often results in significant time delay between detection of flap compromise and intervention. Among emerging flap monitoring technologies, the most promising appear to be those that rely on noninvasive transcutaneous oxygen and carbon dioxide measurements, which provide information regarding flap perfusion. In this article, we review and summarize the literature on various techniques but primarily emphasizing those technologies that rely on transcutaneous gas measurements. We also define characteristics for the ideal flap monitoring tool and discuss critical barriers, predominantly cost, preventing more widespread utilization of adjunct monitoring technologies, and their implications.

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Section: Resultsmentioning

confidence: 99%

Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements

Halani

Hembd

et al. 2022

Journal of Hand and Microsurgery

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“…Transcutaneous O 2 sensing can also be performed using dynamic phosphorescence imaging, which has been shown to be equally effective when compared with the use of electrodes. 18 While tissue oximetry monitoring allows for more data that aid in the assessment of the flap, the utility of the numbers derived from these devices is not well established. One confounding factor is the variability in the anatomy of the flap, as oftentimes perforators are found in different places of the flap.…”

Section: Discussionmentioning

confidence: 99%

Tissue Oximetry Readings Accurately Predict Late Complications in Patients Undergoing Free Flap Breast Reconstruction: Exploring the Optimal Cut Point Value

Saad

Wang

Karamanos

2020

J Reconstr Microsurg

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Background The use of tissue oximetry for monitoring following free tissue transfer has become a common practice across the United States to facilitate early detection of poor flap perfusion in the postoperative setting. There is no consensus on the optimal value, below which there is a higher chance of wound complications in patients undergoing free flap breast reconstruction. Methods Patients undergoing free flap breast reconstruction from 2015 to 2018 were retrospectively reviewed. Patients who returned to the operating room for a revision of the anastomosis were excluded from analysis. Patients were divided in two groups based on the development of late complications. Those were defined as fat necrosis, wound dehiscence, or distal flap ischemia/necrosis that developed after discharge from the hospital. Mean percutaneous oximetry readings of the first 24 hours were recorded and the mean change from the initial reading was calculated. The correlation between tissue oximetry change and development of complications was explored. Results A total of 120 patients were identified. The mean age was 53, while the mean body mass index was 33. A total of 38 patients developed late wound complication. History of smoking, diabetes mellitus, neoadjuvant radiation therapy, and the mean change of the tissue oximetry reading were identified as independent predictors of wound complications. The absolute number of the tissue oximetry reading did not predict late complications. A multivariate analysis revealed that patients who experienced a mean decrease < 15% from the initial reading during the first 24 hours were significantly more likely to develop late flap-related wound complications. Conclusion In patients undergoing free tissue breast reconstruction, tissue oximetry readings do not predict late wound complications. However, the mean change at 24 hours from the initial reading does. A decrease of <15% in tissue perfusion was associated with a significant increase in the probability of developing flap-related wound complications.

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“…Previous reports of time‐based trends in postoperative flap oximetry and blood flow are contradictory. Several authors have shown a postoperative decrease in flap oxygen saturation or a transient increase, while others have found stable flap oxygenation . The increase in TOx has been explained by vasodilation (because of autonomic denervation, increased inflammatory reaction and ischemia) and by progressive dissolution of microthrombi .…”

Section: Discussionmentioning

confidence: 99%

“…skin thickness and density of capillary network) to tissue perfusion is known and possible contribution of systemic factors to perfusion has been anecdotally mentioned . The time‐based changes in oxygenation and blood flow dynamics of free flaps have also been a point of interest and studied repeatedly, however, reports are contradictory …”

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confidence: 99%

Variables affecting postoperative tissue perfusion monitoring in free flap breast reconstruction

Öztürk

Ledinh

et al. 2014

Microsurgery

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Postoperative flap monitoring is a key component for successful free tissue transfer. Tissue oxygen saturation measurement (TOx) with near-infrared spectrophotometry (NIRS) is a method used for this purpose. The aim of this study was to identify external variables that can affect TOx. Patients who had breast reconstruction with free flaps were monitored prospectively and intra-operative details were recorded. Flap TOx was recorded with NIRS pre-extubation, postextubation, and then every four hours for 36 hours. At each of these time points, blood oxygen saturation (SO2), amount of supplemental oxygen, and blood pressure were recorded. Thirty flaps were monitored. Initially, a significant trend over time was detected such that for every increase of 24 hours, TOx decreased on average by 2.1% (P = 0.025). However, when accounting for SO2 levels, this decrease was no longer significant (P = 0.19). An increase by 1% in SO2 produced an increase in TOx reading of 0.36 (P = 0.007). The amount of supplemental O2, systolic blood pressure, and diastolic blood pressure did not have a significant impact on TOx (P > 0.05). The TOx values were highest in the free TRAM flaps and were lower in decreasing order in the muscle-sparing TRAM, DIEP, and SIEA flaps (P > 0.05). The TOx values did not significantly correlate with vessel size, perforator number, or perforator row. Postoperative flap TOx was found to correlate with SO2 and was not significantly dependent on blood pressure, supplemental O2, or surgical variables. Careful interpretation of oximetry values is essential in decision making during postoperative flap monitoring.

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Postoperative assessment of free skin flap viability by transcutaneous pO2 measurement using dynamic phosphorescence imaging

Cited by 13 publications

References 23 publications

Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements

Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements

Tissue Oximetry Readings Accurately Predict Late Complications in Patients Undergoing Free Flap Breast Reconstruction: Exploring the Optimal Cut Point Value

Variables affecting postoperative tissue perfusion monitoring in free flap breast reconstruction

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