Monitoring the changes in intraparenchymatous venous pressure to ascertain flap viability.
BACKGROUND
Disruption of venous outflow can lead to tissue necrosis. Thrombosis of a venous channel at the coaptation site in instances of free tissue transfer could cause death of the transplanted tissues. Although various techniques have been used to monitor the viability of transferred tissues, there has been no technique designed specifically to check the flow within and the patency of the venous channel. The authors have devised an approach with which to monitor the changes in venous pressure in a composite tissue transferred by means of microsurgical technique for bodily reconstruction.


METHODS
The status of the venous system in various composite tissue grafts was monitored at the time of surgery or for 3 days after the completion of surgery by placing a small-caliber catheter in the vein within the transferred tissue. A total of 52 patients participated in the study.


RESULTS
The venous pressure noted in grafts with a patent venous channel remained constant within a range between 0 and 35 mmHg. Venous insufficiency was detected in three of the 52 cases, with unmistakable findings of an elevated venous pressure of over 50 mmHg.


CONCLUSIONS
The technique of measuring the venous pressure by means of an indwelling venous catheter to monitor changes was found to accurately assess the patency of the venous channel and, by inference, the viability of the transferred tissue. No morbidity was associated with the technique.
Sakurai
Hiroyuki
H
Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University.
Nozaki
Motohiro
M
Takeuchi
Masaki
M
Soejima
Kazutaka
K
Yamaki
Takashi
T
Kono
Taro
T
Fukaya
Eri
E
Yamamoto
Yusuke
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001795:Blood Pressure Determination / Q000295:instrumentation*; D002406:Catheterization, Peripheral; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013524:Surgical Flaps / Q000098:blood supply*; D014022:Tissue Survival / Q000502:physiology*; D014680:Veins; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000209:etiology; D014690:Venous Pressure; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis*