Early monitoring of the viability of the buried intrathoracic omental flap: a feasibility study.
OBJECTIVE
The value of mobile, high-resolution gray-scale and color Doppler ultrasonography (US) in the immediate postoperative, intensive care setting for monitoring the buried flap and vascular pedicle of the laparoscopic or transdiaphragmatic harvested omentum for intrathoracic reconstruction was evaluated. In addition to flow, flap position, size, and findings of flap necrosis, other flap-related complications were investigated.


METHODS
Two patients with deep sternal wound infection after coronary artery bypass grafting suspected with impending flap failure and reoperation in the immediate postreconstructive period were examined with a Philips HDI-5000 US scanner (Philips Medical Systems, Best, The Netherlands) equipped with an L12-5 MHz linear-array transducer at the bedside. The US findings were defined and the therapeutic decisions that were made based on the information gleaned, were compared with computed tomography controls and the eventual clinical outcomes.


RESULTS
Flow and flap viability could easily and repeatedly be demonstrated and recorded with the aid of high-resolution gray-scale and color-Doppler US. Despite the unusual, buried position of the pedicle and omental flap, the information gleaned was sufficient to reach a decision that prevented unnecessary surgery.


CONCLUSIONS
Mobile high-resolution gray-scale US, combined with color Doppler US, was confirmed to be accurate and promises to be a valuable noninvasive tool for the immediate postoperative assessment of pedicle and intrathoracic omental flap perfusion and viability. It may also avert unnecessary and difficult surgical revision of an elegant but sensitive flap reconstruction.
van Wingerden
Jan J
JJ
Department of Plastic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. jjvw06@gmail.com
Collins
James M P
JM
Coret
Elbertus H
EH
Schröder
Peter J J
PJ
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003646:Debridement; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D054843:Negative-Pressure Wound Therapy; D009852:Omentum / Q000098:blood supply* / Q000637:transplantation*; D019651:Plastic Surgery Procedures; D012086:Reoperation; D013249:Sternum; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color