A Simple Way to Measure Glucose and Lactate Values During Free Flap Head and Neck Reconstruction Surgery

Kishi, Keita; Ishida, Katsuhiro; Makino, Yojiro; Miyawaki, Toshio

doi:10.1016/j.joms.2018.08.015

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Even in well-perfused free flaps, the CBG levels change significantly over the course of 48 hours postoperatively in stable patients. 10 Our study results demonstrate that the index test (difference in the CBG of patient and free flap) has an excellent diagnostic accuracy in diagnosing an impending free flap failure. The cut-off value in overall patients is 24.5 mg/dL.…”

Section: Discussionmentioning

confidence: 62%

Difference between Capillary Blood Glucose of Free Flap and the Patient: A Novel Objective Marker of Free Flap Vascular Compromise during Postoperative Monitoring

Chakraborty

Sahu

Midya

et al. 2022

Indian J Plast Surg

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Background Defining cut-off values of flap glucose levels in diagnosing free flap vascular compromise, without taking patients' glucose levels into account, does not hold good in all circumstances, especially in cases of high fluctuations in patients' capillary blood glucose and in diabetic patients. The aim of our study was to establish the role of capillary blood glucose measurements of the flap in relation to patients' fingertip, as an objective tool for postoperative free flap monitoring. Methods A total of 76 free flaps underwent postoperative monitoring with reference test (clinical parameters) and simultaneously with our index test (difference between capillary blood glucose of free flap and the patient), in non-diabetic and diabetic patients. Patients' demography and flap characteristics were also recorded. An ROC curve was plotted to determine diagnostic accuracy and cut-offs of the index test in diagnosing free flap vascular compromise. Results Our Index test has a cut-off value of 24.5 mg/dL with 68.75% sensitivity and 93% specificity, with an accuracy of 91.54%. Conclusion The difference between capillary blood glucose of free flap and the patient is simple, feasible, and inexpensive, and can be done by any health care professional and does not require any specialized facilities or training. It has an excellent diagnostic accuracy to detect impending free flap vascular compromise, especially in non-diabetics. Although in diabetics, this test becomes less accurate. Being an observer-independent objective test, the difference in capillary blood glucose of patient and flap measurement can be used as a highly reliable tool for postoperative free flap monitoring.

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Section: Discussionmentioning

confidence: 62%

Difference between Capillary Blood Glucose of Free Flap and the Patient: A Novel Objective Marker of Free Flap Vascular Compromise during Postoperative Monitoring

Chakraborty

Sahu

Midya

et al. 2022

Indian J Plast Surg

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“…Therefore, the flap glucose measurement has more application value. Kishi et al 33 used various types of free flaps to repair craniofacial tumors on scalp, maxillary, mandible, midface, oral cavity, or tongue. In the process of postoperative monitoring, the flap glucose was found to be able to reflect flap blood flow abnormalities and guide salvage surgery.…”

Section: Discussionmentioning

confidence: 99%

“…For patients with poorly controlled diabetes, capillary lactate values in flaps can also be used as a monitoring index in addition to the interstitial glucose level, as lactate significantly increases after flap perfusion failure. 11,18,20 A portable blood lactate analyzer is also available in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Based on this phenomenon, other studies subsequently confirmed and expanded these results to clinical monitoring. [13][14][15][16][17][18][19][20][21][22][23][24] The evidence demonstrates that flap glucose measurement is a diagnostically valid method to detect flap venous occlusion. Furthermore, Sitzman et al 23 used the continuous interstitial glucose monitor (CIGM) as a more convenient way of detecting flap interstitial glucose levels.…”

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confidence: 99%

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Continuous Interstitial Glucose Measurement for Flap Venous Occlusion Monitoring in a Diabetic Model

Zhang

Wang

et al. 2022

Journal of Craniofacial Surgery

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Glucose has been used in the monitoring of transplanted flaps. However, few studies have focused on the effect of diabetes on the decrease in flap glucose levels. The purpose of this study was to evaluate the application of continuous interstitial glucose monitoring to detect flap venous occlusion in a diabetic rat model. The flap interstitial glucose level was measured by transcutaneous sensors in the bilateral vertical rectus abdominis myocutaneous flaps of each rat. interstitial glucose values in the bilateral flaps were recorded every 5 minutes after the venous occlusion of 1 flap. Forty-one rats were divided into the control group (n = 13), diabetic group (n = 15, established by the intraperitoneal injection of streptozotocin), and insulintreated diabetic group (n = 13, systemic glucose well controlled by insulin before surgery). Results indicated that flap interstitial glucose decreased to the lowest level in all flaps with venous occlusion. The time from venous occlusionto the lowest interstitial glucose level was significantlylongerinthe diabetic group than the control group (120.8 ± 5.7 minutes versus 56.5 ± 6.7 min-minutes, P < 0.001), but was similar in the insulintreated diabetic and control groups (56.5 ± 6.7 minutes versus 56.0 ± 6.6 minutes, P = 0.876). The change in interstitial glucose in both the diabetic and insulin-treated diabetic groups began with a plateau period or a slow decline before decreasing for 49.0 ± 6.4 minutes and 24.4 ± 4.3 min-minutes, respectively. in a diabetic rat model, impaired glucose metabolism prolongs the required monitoring time and dulls the reaction of flap interstitial glucose to venous congestion. Insulin restores the prolonged monitoring time, but not the reaction of flap interstitial glucose. Therefore, care is needed during application of the technique in diabetic patients.

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“…The anaesthetic management of these patients covers a wide array of clinical situations from the management of difficult airways to very long duration anaesthesia (>8 hours). Hyperlactatemia is commonly observed in reconstructive oncoplastic surgery patients[ 5 ] and hence a study was designed to find any association of hyperlactatemia with patient profile and intraoperative factors. It was planned to establish the role of hyperlactatemia as a prognostic marker of outcome in oncoplastic surgeries.…”

Section: Introductionmentioning

confidence: 99%

Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?

Roy

Bharti

Sinha

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery. Material and Methods: A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit. Results: The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups. Conclusion: Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.

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A Simple Way to Measure Glucose and Lactate Values During Free Flap Head and Neck Reconstruction Surgery

Cited by 8 publications

References 24 publications

Difference between Capillary Blood Glucose of Free Flap and the Patient: A Novel Objective Marker of Free Flap Vascular Compromise during Postoperative Monitoring

Difference between Capillary Blood Glucose of Free Flap and the Patient: A Novel Objective Marker of Free Flap Vascular Compromise during Postoperative Monitoring

Continuous Interstitial Glucose Measurement for Flap Venous Occlusion Monitoring in a Diabetic Model

Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?

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