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

Abstract

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.

Complex reconstruction of the clavicle with a prefabricated medial femur condyle chimeric flap including a superficial circumflex iliac artery perforator flap: A case report

“…In the field of monitoring buried free flaps, numerous devices have been reported in the existing literature ranging from Dopplers to state of the art wireless implantable optical probes (Guo et al, 2022; Molitor et al, 2021a, 2021b). Among these devices, implantable Dopplers have gained significant popularity and may have been utilized in our specific case (Agha et al, 2014; Dunklebarger et al, 2022; Tabrizi et al, 2021).…”

Superb Microvascular Imaging at Evaluation of Nonvisible Buried De-epitelized Flap Vascularization in Breast Reconstruction

“… 12 The most common and accepted method is clinical observation, but it depends on skin color, temperature, turgor, capillary return, elasticity, etc. 13 Since de-epitelized flaps do not include skin, monitoring is difficult, skin island can be protected but it leads to a patch image. Ideally, flap monitoring should be cost-effective, simple to be applied, harmless to patient and flap, rapid to obtain, provide reliable and objective data, and be suitable for all types of flaps.…”