title: Three-year experience using near infrared spectroscopy tissue oximetry monitoring of free tissue transfers.
abstract: Early recognition of threatened free-flap failure is paramount to flap salvage. A noninvasive, reproducible, sensitive monitoring tool would be a useful adjunct to clinical examination. The purpose of this study was to examine outcomes using a near-infrared spectroscopy (NIRS) tissue oximeter for postoperative flap monitoring. A total of 128 free flaps were performed in 113 patients over a 3 year period. The patients were divided into 2 cohorts: conventional monitoring (group 1) and conventional monitoring plus NIRS oximetry (group 2). Overall flap survival was 90.6% in group 1 and 98.7% in group 2 (P = 0.05). Overall survival of threatened flaps was 0% (0/5) in the conventional group and 87.5% (6/7) in the oximeter group, P = 0.005. Salvage of operated flaps was significantly improved in group 2: 0% (0/4) in group 1 versus 100% (3/3) in group 2, P = 0.03. The sensitivity, specificity, and predictive values for detecting threatened flap loss were 100%. The NIRS tissue oximeter is a highly reliable, sensitive, and specific, noninvasive method for postoperative free tissue transfer monitoring.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. matthew.steele@surgery.ufl.edu
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult