Results of monitoring fasciocutaneous, myocutaneous, osteocutaneous and perforator flaps: 4-year experience with 166 cases.
Four free-flap types were compared regarding perioperative blood perfusion parameters and to define critical values for success. 166 cases were investigated: radial forearm flap (fasciocutaneous, n=89); fibula flap (osteocutaneous, n=32); ALT flap (myocutaneous, n=25); soleus perforator flap (n=20). All flaps were monitored with simultaneous laser-Doppler flowmetry and tissue spectrophotometry intra- and postoperatively up to 14 days. In 24 (15%) of 166 cases perfusion irregularity occurred. Operative exploration was performed in 12 cases (9 successful). 11 flaps (5 radial forearm, 3 fibula, 2 ALT, 1 perforator) were lost due to vascular compromise, which led to an overall success rate of 93%. Rapid increase in haemoglobin concentration of >30% identified venous congestion. Abrupt decline of blood flow and haemoglobin oxygenation indicated arterial occlusion. For radial forearm flaps haemoglobin oxygenation of 15% and a deep flow of 20 AU were identified as minimum values for flap viability. For fibula, ALT, and perforator flaps haemoglobin oxygenation of 10% and a deep flow of 15 AU were determined as the minimum values. This non-invasive technique was an accurate method for evaluating viability of free-flaps.
Hölzle
F
F
Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Germany. hoelzle@mkg.med.tum.de
Rau
A
A
Loeffelbein
D J
DJ
Mücke
T
T
Kesting
M R
MR
Wolff
K-D
KD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis; D001783:Blood Flow Velocity / Q000502:physiology; D016025:Bone Transplantation / Q000473:pathology*; D002648:Child; D005205:Fascia / Q000098:blood supply / Q000637:transplantation*; D005260:Female; D006085:Graft Survival; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D016038:Skin Transplantation / Q000473:pathology*; D013053:Spectrophotometry; D013524:Surgical Flaps / Q000098:blood supply* / Q000145:classification; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D006454:Hemoglobins; D010100:Oxygen