Thermoregulatory response of anterolateral thigh flap compared with latissimus dorsi myocutaneous flap: An evaluation of flaps cutaneous flow and velocity due to thermal stress

Rahmanian-Schwarz, Afshin; Schiefer, Jennifer Lynn; Amr, Amro; Rothenberger, Jens; Schaller, Hans-Eberhard; Hirt, Bernhard

doi:10.1002/micr.20950

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…This state is improved over time as the flaps become independent of the pedicle by vessel ingrowth from the surrounding tissue (randomization) and regain basic innervation. 8,16 However, these effects take place over a longer span of time, while the short-term changes described in this work are more likely attributable to the vascular changes discussed in the following.…”

Section: General Considerationsmentioning

confidence: 83%

Changes of Oxygenation and Hemoglobin-Concentration in Lower Extremity Free Flaps during Dangling

Kolbenschlag

Bredenbroeker

Daigeler

et al. 2014

J reconstr Microsurg

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Lower extremity reconstruction utilizing free tissue transfer has become a common and safe procedure. Postoperative care and especially timing and duration of dangling however have not yet been extensively studied. We therefore aimed to assess the changes in oxygenation and hemoglobin concentration in lower extremity free flaps during dangling. A total of 19 patients who underwent microsurgical reconstruction of the lower leg (nine parascapular, five latissimus dorsi, and five anterolateral thigh [ALT] flaps) were included in a prospective study. Beginning on the 6th postoperative day (POD), dangling was commenced three times a day for 5 minutes each and gradually increased over time. Oxygenation and concentration of hemoglobin was measured using noninvasive near infrared spectroscopy. A specific pattern of oxygenation and hemoglobin concentration was identified. After beginning of dangling, oxygenation and hemoglobin concentration rises, followed by a rapid decrease. Over the course of training, the predangling saturation values increased steadily, resulting in a 9.5% increase on POD 9. The time needed for the flap to regain its predangling oxygenation level declined over the course of training from 5.1 minutes on POD 6 to 3.8 minutes on POD 9. The ALT flaps showed the highest increase in predangling saturation values (12%) and the most pronounced decrease in recovery time (6.7 minutes on POD 6 vs. 3.5 minutes on POD 9). The type of flap seems to influence behavior during dangling. However, further influencing factors need to be identified to enable reconstructive surgeons to tailor not only the flap but also the aftercare to the individual patient.

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Section: General Considerationsmentioning

confidence: 83%

Changes of Oxygenation and Hemoglobin-Concentration in Lower Extremity Free Flaps during Dangling

Kolbenschlag

Bredenbroeker

Daigeler

et al. 2014

J reconstr Microsurg

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“…3 The used method in this study (Oxygen to See, O2C, Lea Medizintechnik, Germany) combines lightguide tissue spectrophotometry and laser Doppler flowmetry. Both methods were used separately in a large number of human, [4][5][6][7][8][9][10] and animal studies. [11][12][13][14][15] The O2C device allows measurements of blood flow (flow) and blood velocity using Doppler flowmetry.…”

mentioning

confidence: 99%

Evaluation of a non‐invasive monitoring method for free flap breast reconstruction using laser doppler flowmetrie and tissue spectrophotometry

Rothenberger¹,

Amr²,

Schaller³

et al. 2013

Microsurgery

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Background: Despite advances in the monitoring of free flaps, there is still a demand for new technology to detect ischemic complications at an early stage. The aim of the present study was to evaluate the reliability of the O2C-device in terms of detecting flap failure in commonly used perforator flaps for breast reconstruction. Methods: A total of 34 patients undergoing breast reconstruction were involved in this study. The perfusion dynamics of 23 deep inferior epigastric perforator flaps and 11 superior gluteal arterial perforator flaps were assessed using the O2C-device, which combines a laser light, to determine blood flow (flow), velocity, and white light to determine hemoglobin oxygenation (SO 2 ) and relative amount of hemoglobin (rHB). Measurements were carried out intra-operatively after clamping and declamping the perforator vessels. In the post-operative period measurements were carried out every hour for the first 48 hours and from 3rd to 7th for every 2 hours. These dates were compared to findings of clinical assessment. Results: Several intra-operative measurements, during the clamping and declamping the different perforator vessels, revealed a high correlation for all parameters: Flow (r 5 0.89, P < 0. 05), Velo (r 5 0.92, P < 0. 05), SO 2 (r 50.84, P <0. 05), and rHB (r 50.83 P < 0.05). Vessel occlusion was detected in five cases, of which three were due to arterial thrombosis and two further cases were due to venous occlusion. Of the five cases, one flap loss caused by venous occlusion was noted. Conclusion: The O2C-device seems to be a reliable, objective, and non-invasive device for the monitoring of free flaps. Thus, it may improve flap survival rates by detecting vascular compromise at an early stage. V V C 2013 Wiley Periodicals, Inc. Microsurgery 33: 350-357, 2013.

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“…The technical details and the methodology of O2C measurements have previously been described in detail. 15,18,19 In short, an O2C measurement channel is equipped with a laser-Doppler measurement unit (830 nm and 30 mW) and a tissue-spectrometer unit with a white light source (20 W, 500-800 nm, and 1-nm resolution). By transferring scattered light into electric signals, the O2C device measures blood flow (flow), detects hemoglobin SO 2 , and the rHB.…”

Section: Measurements Using the Oxygen To See Devicementioning

confidence: 99%

The 72-Hour Microcirculation Dynamics in Viable Free Flap Reconstructions

Moellhoff

Gernert

Frank

et al. 2022

J Reconstr Microsurg

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Background The risk for vascular complications is the highest within the first 24 hours after free flap transfer. Clinical signs of critical perfusion are often recognized with time delay, impeding flap salvage. To detect failing flaps as soon as possible and to prevent persisting microvascular impairments, knowledge of physiological perfusion dynamics in free flaps is needed. Aim of this study was to investigate the physiological perfusion dynamics of viable free flaps using the Oxygen to See (O2C) device for continuous monitoring. Methods Microcirculation was continuously monitored in 85 viable free flaps over a period of up to 72 hours following microvascular anastomosis using tissue spectrophotometry and laser Doppler flowmetry (O2C, LEA Medizintechnik, Gießen, Germany). The parameters investigated included capillary-venous blood flow (flow), oxygen saturation (SO2), and relative amount of hemoglobin (rHB). Results Microcirculatory blood flow increased significantly overall, especially within the first 18 hours after microsurgical anastomosis, after which peak formation was occurred. Mean values of SO2 showed a decreasing trend and the steepest decrease of SO2 (slope: 1.0) occurred during the steepest increase of flow between 3 and 6 hours (slope: 4.7) postanastomosis. The rHB values remained fairly constant throughout the study period. Conclusion Hyperemia after free flap transfer accounts for a significant increase of microvascular flow. Tissue oxygenation is reduced, likely due to an increase of oxygen consumption after anastomosis. A better understanding of physiological perfusion dynamics in free flaps can aid surgeons in recognizing compromised vasculature earlier and improve free flap salvage.

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Thermoregulatory response of anterolateral thigh flap compared with latissimus dorsi myocutaneous flap: An evaluation of flaps cutaneous flow and velocity due to thermal stress

Cited by 7 publications

References 24 publications

Changes of Oxygenation and Hemoglobin-Concentration in Lower Extremity Free Flaps during Dangling

Changes of Oxygenation and Hemoglobin-Concentration in Lower Extremity Free Flaps during Dangling

Evaluation of a non‐invasive monitoring method for free flap breast reconstruction using laser doppler flowmetrie and tissue spectrophotometry

The 72-Hour Microcirculation Dynamics in Viable Free Flap Reconstructions

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