title: Changes of perfusion of microvascular free flaps in the head and neck: a prospective clinical study.
abstract: Reconstruction with a free flap is routine in head and neck surgery. However, reliable assessment of perfusion can be difficult, so we prospectively evaluated it in 4 types of microvascular free flaps in the oral cavity (n=196) and assessed differences in blood flow by non-invasive monitoring with a laser Doppler flowmetry unit. We measured oxygen saturation, haemoglobin concentration, and velocity on the surface of the flap preoperatively at the donor site, and on the flap on the first, second, and seventh postoperative days, and after 4 weeks in 186/196 patients, mean (SD) age of 60 (13) years. We studied the radial forearm (n=76, 41%), fibular (n=45, 24%), anterolateral thigh (n=53, 28%), and soleus perforator (n=12, 7%) flaps. The values for the radial forearm flap differed significantly from the others. There were significant differences in haemoglobin concentrations between the fibular and soleus perforator flaps, and between the anterolateral thigh and soleus perforator flaps (p=0.002 each). Free flaps are unique in the way that perfusion develops after microvascular anastomoses. Knowledge of how each flap is perfused may indicate different patterns of healing that could potentially influence long term rehabilitation and detection of future deficits in perfusion.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany. Electronic address: th.mucke@gmx.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rau
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Merezas
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kanatas
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: David A
authors.initials: DA
authors.lastname: Mitchell
authors.affiliation: Institute for Medical Statistics and Epidemiology, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Steiner
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001783:Blood Flow Velocity / Q000502:physiology; D016025:Bone Transplantation; D005360:Fibula / Q000098:blood supply / Q000637:transplantation; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000379:methods; D008875:Middle Aged; D009055:Mouth / Q000601:surgery*; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D011884:Radius / Q000098:blood supply / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D016038:Skin Transplantation; D013848:Thigh / Q000098:blood supply; D060053:Transplant Donor Site / Q000098:blood supply
chemical_list: D006454:Hemoglobins; D010100:Oxygen
keywords: Flap; Laser-Doppler spectroscopy; Oral cavity; Perfusion