Free flap reconstruction is a common procedure with success rates greater than 99%. However, vascular complications may occur, resulting in flap failure. For this reason, early detection of vascular compromise is crucial for flap salvage. Vascular complications may be detected early by monitoring tissue oximetry parameter changes using near-infrared spectroscopy (NIRS). This method of noninvasive monitoring can evaluate changes in flap oxygenation levels caused by arterial and venous thrombosis before surgical reexploration. The goal of this study was to assess the validity of using NIRS oximetry for monitoring free flaps. We conducted a prospective cohort observational study of 10 patients undergoing breast reconstruction. We used the INVOS 7100 cerebral oximetry monitoring system (Medtronic, Dublin, Ireland) to provide 24-hr continuous postoperative monitoring of flap perfusion and compared the data with clinical assessment findings. The median patient age was 57 years (range = 41–61 years). Patients underwent immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap surgery (n = 4), delayed reconstruction with DIEP flap surgery (n = 4), transverse upper gracilis flap surgery (n = 1), and latissimus dorsi flap with lipofilling (n = 1). We successfully monitored all 10 flaps for 24 hr postoperatively. The overall flap survival rate was 100%. Findings of clinical examination, Doppler studies, and surgical outcome were consistent with NIRS monitoring. In conclusion, NIRS tissue oximetry could potentially provide a noninvasive method for effective postoperative monitoring of free flaps.

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D ear Editor,Blood is a valuable resource that has specific guidance related to its safe and effective use (National Institute for Health and Care Excellence, 2015). In an effort to reduce the number of blood transfusions in our burn patients, we audited and changed our practice guidelines, resulting in a 100% reduction of unnecessary crossmatching investigations, thus increasing resources and reducing costs. Our previous practice guidelines recommended Group and Save (i.e., determining patient blood group [ABO and RhD] and screening for atypical antibodies) as a minimum for all burn patients undergoing operative treatment regardless of burn size. For patients with burns on more than 10% of their body requiring operative treatment, we routinely crossmatched two units of red blood cells and other blood products as considered necessary based on individual patient circumstances.Since implementing these guidelines, we have changed the way we treat burns. We now routinely perform enzymatic debridement (ED) of burns. Enzymatic debridement involves the application of a debriding enzyme in the form of a gel dressing. In many cases, ED can be performed outside of the operating room. The procedure is performed under local, regional, or general anesthesia as needed, and patients tolerate this procedure very well.We retrospectively reviewed 47 patients who were referred to our unit with burns on more than 10% of their total body surface area (TBSA). The patients were grouped according to the percentage of TBSA of their burns: 10%-20% (n = 31), 20%-30% (n = 10), and 30%-40% (n = 6). A total of 12 patients underwent ED, 32 underwent surgical debridement, and three were managed conservatively. Within the ED group, there were eight patients in the 10%-20% TBSA group and four patients in the 20%-30% TBSA group. None of these patients (n = 12) required a blood transfusion. Within the surgical debridement group, there were 20 patients in the 10%-20% TBSA group and