Micro-lightguide spectrophotometry as an intraoral monitoring method in free vascular soft tissue flaps.
OBJECTIVE
The aim of this prospective study was to measure the hemoglobin oxygen saturation (HbO(2)%) and relative Hb concentration of free vascular soft tissue flaps using micro-lightguide spectrophotometry. The objective was to measure the normal range and topographic differences in HbO(2)% and rel. Hb conc. in tissue transfers before establishing this as a clinical method for monitoring perfusion and vitality.


METHODS
In 39 patients who had received free vascular soft tissue flaps (34 radial forearm flaps; 8 latissimus flaps) to cover defects after tumor surgery, the capillary HbO(2)% in transferred tissue was measured spectrophotometrically preoperatively at the donor site and postoperatively up to the third postoperative day. On average about 500 hemoglobin spectra (200 to 800 spectra) were measured over each 24-hour period. Additionally, the relative Hb concentration was determined for the individual measuring times. The measurements were carried out topographically on the flap base, flap center, and flap periphery.


RESULTS
The preoperative HbO(2) values at the donor site of free soft tissue flaps were between 20% and 40% in all topographic regions. In the case of clinically successful flaps, a normal distribution of the HbO(2) values of 20% to 80% was obtained in the immediate postoperative period, and from the second day on, a normal distribution of 45% to 60%. In the case of 2 flaps with partial necrosis, HbO(2) values of less than 10% to 15% were measured from the second postoperative day on. The relative Hb concentration had no influence on the amount of HbO(2)% measured in the transferred capillaries. In the postoperative phase, here was no topographic difference between the individual flap regions.


CONCLUSIONS
As a noninvasive method, micro-lightguide spectrophotometry permits quantitative determination of HbO(2)% and relative Hb concentration over the entire surface of soft tissue flaps. In the case of partially unsuccessful flaps, HbO(2) values of less than 10% to 15% were measured beforehand, thus indicating that these HbO(2) values are not sufficient to support the vitality of the free tissue transfer. When combined with clinical observation, application can be recommended for the vitality measurement of free soft tissue flaps and permits more information to be obtained on topographic capillary perfusion conditions.
Schultze-Mosgau
Stefan
S
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany. stefan.schultze-mosgau@mkg.imed.uni-erlangen.de
Wiltfang
Joerg
J
Birklein
Frank
F
Neukam
Friedrich Wilhelm
FW
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008833:Microcirculation; D015591:Microspectrophotometry / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009062:Mouth Neoplasms / Q000601:surgery; D019647:Oral Surgical Procedures / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011184:Postoperative Period; D011446:Prospective Studies; D012016:Reference Values; D015424:Reperfusion; D013524:Surgical Flaps / Q000098:blood supply*
D006454:Hemoglobins; D010100:Oxygen