title: Post-operative monitoring of free muscle transfers by Laser Doppler Imaging: A prospective study.
abstract: OBJECTIVE
  Despite different existing methods, monitoring of free muscle transfer is still challenging. In the current study we evaluated our clinical setting regarding monitoring of such tissues, using a recent microcirculation-imaging camera (EasyLDI) as an additional tool for detection of perfusion incompetency.
  
  
  METHODS
  This study was performed on seven patients with soft tissue defect, who underwent reconstruction with free gracilis muscle. Beside standard monitoring protocol (clinical assessment, temperature strips, and surface Doppler), hourly EasyLDI monitoring was performed for 48 hours. Thereby a baseline value (raised flap but connected to its vascular bundle) and an ischaemia perfusion value (completely resected flap) were measured at the same point.
  
  
  RESULTS
  The mean age of the patients, mean baseline value, ischaemia value perfusion were 48.00 ± 13.42 years, 49.31 ± 17.33 arbitrary perfusion units (APU), 9.87 ± 4.22 APU, respectively. The LDI measured values in six free muscle transfers were compatible with hourly standard monitoring protocol, and normalized LDI values significantly increased during time (P < 0.001, r = 0.412). One of the flaps required a return to theatre 17 hours after the operation, where an unsalvageable flap loss was detected. All normalized LDI values of this flap were under the ischaemia perfusion level and the trend was significantly descending during time (P < 0.001, r = -0.870).
  
  
  CONCLUSIONS
  Due to the capability of early detection of perfusion incompetency, LDI may be recommended as an additional post-operative monitoring device for free muscle flaps, for early detection of suspected failing flaps and for validation of other methods.
authors.affiliation: University Clinic for Plastic, Reconstructive and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Tschumi
authors.affiliation: University Clinic for Plastic, Reconstructive and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.|University Clinic for Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: S Morteza
authors.initials: SM
authors.lastname: Seyed Jafari
authors.affiliation: University Clinic for Plastic, Reconstructive and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Rothenberger
authors.affiliation: Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.|Institute of Bioengineering, Ecole Polytechnique Fédérale De Lausanne, Lausanne, Switzerland.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Van de Ville
authors.affiliation: Department of Orthopaedics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Marius
authors.initials: M
authors.lastname: Keel
authors.affiliation: Department of Orthopaedics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Krause
authors.affiliation: University Clinic for Plastic, Reconstructive and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Maziar
authors.initials: M
authors.lastname: Shafighi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000637:transplantation; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods