Postoperative Free-Flap Monitoring Techniques

Abstract

Free tissue transfer is commonly employed in the reconstruction of large or complicated defects. Postoperative flap failure from microvascular compromise is an uncommon but major potential complication of this procedure. As such, many postoperative monitoring techniques devices have been developed. This paper provides an overview of the wide variety of options available for surgeons today.

Nursing Monitoring of Microsurgical Free Flaps: Identifying and Addressing Knowledge Gaps

“…17 Clinical monitoring, consisting of flap surface temperature, color, turgor, capillary refill with or without audible Doppler, is the "gold standard" for postoperative flap monitoring and the most commonly used method by microvascular surgeons. 18,19 However, as seen in our study, nursing knowledge of capillary refill and venous congestion as it relates to microsurgical free flaps is inadequate, even for very experienced nurses. Given this subjectivity, we have consistently incorporated tissue oximetry into our monitoring protocols since October of 2014.…”

Effect of short-term ischemia on microcirculation and wound healing of adipocutaneous flaps in the rat

“…Common tools for monitoring flap viability are fluorescein dye and illumination with a Wood lamp, monitoring tissue pH and transcutaneous oxygen tension, surface temperature monitoring, Doppler ultrasound, transit-time ultrasound flowmeter, laser Doppler flowmetry (monitor, scan, confocal laserscan) 12,[18][19][20][21][22][23] . Laser Doppler technique investigates capillary flow by the Doppler-shift in the laser beam that is backscattered from moving red blood cells.…”

“…Although the skin has a relatively wide ischemic tolerance, the border or reversible and irreversible alterations are still unknown. Investigating this issue, various techniques for monitoring flap perfusion and microcirculation provide useful data 12,[16][17][18][19][20][21][22][23] .…”

Handheld Near-Infrared Fluorescence Imaging Device Using Modified Action Cameras for Peri-Operative Guidance of Microvascular Flap Surgery

“…Systems can be broadly categorized as invasive and non-invasive. Implantable Doppler/venous couplers, oxygen tension monitoring, tissue pH monitoring, microdialysis, Technetium-99m scintigraphy, and contrast-enhanced Doppler are invasive while acoustic, color, laser Doppler, microlight-guided spectrophotometry, surface temperature monitoring, and tissue oximetry are non-invasive [ 6 ]. However, no single method has been universally adopted due to one or more shortcomings with regard to ease of use, invasiveness, sensitivity, and cost.…”