title: Tissue oximetry monitoring in microsurgical breast reconstruction decreases flap loss and improves rate of flap salvage.
abstract: BACKGROUND
  Since the inception of microvascular free tissue transfer, flap monitoring has been based on clinical signs. Color, capillary refill, and handheld Doppler have been used for monitoring in the postoperative period; however, subjective clinical examination may delay recognition of flap compromise. Tissue oximeter monitoring offers an objective method for detecting vascular compromise with the measurement of tissue oxygen saturation and real-time flap perfusion.
  
  
  METHODS
  The authors reviewed 614 consecutive microsurgical flaps for breast reconstruction from 2004 to 2010. The authors' first 380 patients underwent clinical flap postoperative monitoring. Starting in June of 2008, the authors used tissue oximetry as an adjunct on 234 consecutive patients. Flap reexploration, flap loss, salvage rate, fat necrosis, and characteristics of vascular compromise were analyzed.
  
  
  RESULTS
  There were 26 instances of flap reexploration (6.8 percent) and 11 flap losses (2.9 percent) before use of tissue oximetry. After tissue oximetry was used, there were 16 instances of flap reexploration (6.8 percent) and one flap loss. The rate of flap reexploration was not statistically significant between groups, but the difference between the flap failure rates is significant (p = 0.025). The flap salvage rate was previously 57.7 percent; after tissue oximetry monitoring, the flap salvage rate was 93.75 percent (p = 0.015).
  
  
  CONCLUSIONS
  The use of tissue oximetry has decreased the authors' flap loss rate and improved the flap salvage rate in microsurgical breast reconstruction. This device is a useful adjunct in flap monitoring during the postoperative period, as it may help decrease flap loss by detecting impending vascular compromise before it becomes clinically evident.
authors.affiliation: Boston, Mass.; and Cincinnati, Ohio From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, and the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Cincinnati Medical Center.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.forename: Minh-Doan
authors.initials: MD
authors.lastname: Nguyen
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.forename: Salih
authors.initials: S
authors.lastname: Colakoglu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Curtis
authors.forename: Adam M
authors.initials: AM
authors.lastname: Tobias
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000379:methods*