title: Monitoring in microvascular tissue transfer by measurement of oxygen partial pressure: four years experience with 125 microsurgical transplants.
abstract: In a prospective study, the characteristics and benefit of an invasive measurement of oxygen partial pressure (pO(2)) with the aid of a polarographic sensor were investigated in 125 microsurgical reconstructions of the head and neck area over a period of 45 months. Measurements were performed over 96 h in eight different types of microsurgically revascularized flaps for extra- and intraoral reconstructions and were evaluated separately for each flap type. Of 125 reconstructions the system indicated malperfusion in 18 cases. Salvage surgery was performed in 17 cases due to venous thrombosis (6 cases), arterial thrombosis (3 cases), a combination of arterial and venous thrombosis (2 cases), rheological problems (3 cases), venous insufficiency by hematoma (2 cases) and kinking of vessels (1 case). In 10 cases salvage surgery was successful, 7 flaps were lost despite salvage surgery. In all these cases, the polarographic probe indicated the necessity of salvage surgery correctly. After 96 h no malperfusion was seen. Postoperatively, a common and characteristic development of the oxygen partial pressure in different types of flaps was seen. Initially, a clear increase of pO(2) could be measured. During 96 h, a slow decrease of pO(2) was observed. In conclusion polarographic measurement of pO(2) can be an excellent apparative supplement for the postoperative clinical control of microsurgically revascularized transplants. In buried flaps, this technique represents the only reliable method for transplant monitoring.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Tübingen, Osianderstraße 2-8, 72076 Tübingen, Germany. drjonas@kabelmail.de
authors.forename: René
authors.initials: R
authors.lastname: Jonas
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaal
authors.forename: Michael
authors.initials: M
authors.lastname: Krimmel
authors.forename: Dirk
authors.initials: D
authors.lastname: Gülicher
authors.forename: Siegmar
authors.initials: S
authors.lastname: Reinert
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hoffmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D004567:Electrodes, Implanted; D005205:Fascia / Q000637:transplantation; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009062:Mouth Neoplasms / Q000601:surgery; D018482:Muscle, Skeletal / Q000637:transplantation; D010100:Oxygen / Q000097:blood*; D010313:Partial Pressure; D011048:Polarography / Q000295:instrumentation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012039:Regional Blood Flow / Q000502:physiology; D016879:Salvage Therapy; D016038:Skin Transplantation / Q000379:methods; D014689:Venous Insufficiency / Q000175:diagnosis; D020246:Venous Thrombosis / Q000175:diagnosis; D055815:Young Adult
chemical_list: D010100:Oxygen