Dermofluorometry: thresholds for predicting flap survival.
The dye fluorescence index (DFI) has been cited as an accurate predictor of skin-flap survival. However, two thresholds, one each for flap survival and flap necrosis, have been advocated. A DFI of less than 15 to 20 percent predicts failure, and a DFI greater than 35 to 50 percent predicts survival. Values of 20 to 35 percent indicate an uncertain outcome. The present study was undertaken (1) to determine the optimum threshold for flap survival prediction in pigs, and (2) to compare dermofluorometry with flap blood flow as measured by radioactive microspheres. Dermofluorometry was found to be an accurate (90 percent) and repeatable predictor of skin and fasciocutaneous flap survival in pigs. At 2 and 5 hours after flap elevation, the optimum DFI thresholds are 7 and 27 percent, respectively. This reflects the dynamic nature of circulation in acute skin flaps and the increased dye delivery over time. Using these calculated thresholds, a high degree of correlation was found with survival estimated at 24 hours. Dermofluorometry also was correlated with the blood flow index. Thus not only is it an accurate flap monitor, but a quantitative estimate of flap blood flow can be obtained.
Thomson
J G
JG
Division of Plastic Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada.
Kerrigan
C L
CL
D000818:Animals; D062109:Dermatologic Surgical Procedures; D019793:Fluorescein; D005452:Fluoresceins; D005470:Fluorometry; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply*; D013524:Surgical Flaps; D013552:Swine
D005452:Fluoresceins; D019793:Fluorescein