Free flap monitoring: A review of current practice

Hirigoyen, Martin B.; Urken, Mark L.; Weinberg, Hubert

doi:10.1002/micr.1920161103

Cited by 102 publications

(74 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Detection requires constant vigilance in the perioperative period, and clinical acumen remains the predominate monitoring technique, relying on assessment of colour, capillary refill, surface temperature and pinprick bleeding, if indicated (1-4). Nevertheless, adjunctive monitoring devices are also used frequently and have proved to be invaluable, even with experienced recovery personnel (2). The ideal monitor should be objective, provide a continuous recording of perfusion and show immediate recognition of anastomotic occlusion, and all events must be easily interpretable (1,5).…”

mentioning

confidence: 99%

“…Doppler ultrasound or laser Doppler flowmetry have universally become the most commonly used complements to conventional monitoring (2). We use laser Doppler flowmetry to monitor all of our microsurgical composite tissue transfers, beginning intraoperatively, to prevent kinking or stretching of the vascular pedicle, or excessive tension in flap closure.…”

mentioning

confidence: 99%

“…Prompt awareness of such events allows for early reexploration and revision, and the best chance for flap salvage (1,2). Detection requires constant vigilance in the perioperative period, and clinical acumen remains the predominate monitoring technique, relying on assessment of colour, capillary refill, surface temperature and pinprick bleeding, if indicated (1-4).…”

mentioning

confidence: 99%

See 2 more Smart Citations

A comparison of pulse oximetry and laser Doppler flowmetry in monitoring sequential vascular occlusion in a rabbit ear model

Hallock

Rice

2003

Canadian Journal of Plastic Surgery

View full text Add to dashboard Cite

The ultimate success of any free flap transfer depends not only on the experience of the given surgical team, but also requires constant vigilance in the perioperative period to assure continued anastomotic patency. Clinical acumen remains the 'industry' standard, but adjunctive monitoring devices are important to reinforce these subjective evaluations. We routinely use laser Doppler flowmetry in spite of known drawbacks, including expense. On the other hand, we know that pulse oximetry is a possible and readily available alternative. The efficacy of these two monitoring systems was directly compared in a New Zealand white rabbit central artery and vein ear model. Arterial occlusion was immediately recognized by a precipitous drop in flow and oxygen saturation (SaO 2 ). A rapid drop in flow after venous occlusion with a trend to zero was also noted with laser Doppler flowmetry. The SaO 2 had a very slow but steady gradual decline, but values remained in the range of normoxemia for a prolonged time. Because a minimum threshold of SaO 2 for predicting venous occlusion was elusive, the usefulness of pulse oximetry for monitoring microsurgical composite tissue transfers is limited.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

A comparison of pulse oximetry and laser Doppler flowmetry in monitoring sequential vascular occlusion in a rabbit ear model

Hallock

Rice

2003

Canadian Journal of Plastic Surgery

View full text Add to dashboard Cite

show abstract

“…Successful salvage rates range from 28% to over 90%. (3,4,7,14,15) The rates vary depending upon the etiology, timing of salvage and experience of the centre. In a review of 150 cases Hidalgo (8) suggested that attempted salvage of compromised flaps significantly increases flap survival rates and recommended an aggressive approach towards early exploration.…”

Section: Discussionmentioning

confidence: 99%

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

2016

IJASHNB

View full text Add to dashboard Cite

The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in Maxillofacial reconstruction. Although associated complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction. With early recognition and prompt intervention salvage of compromised flap is possible. The purpose of this article is to emphasise the importance of keeping low threshold for re-exploration in situation of any suspected failing free flap. Pt ReportA 60 year-old male patient presented with an ulcero-proliferative mass measuring around 4cmx3.5 cm which involved the right lip mucosa and had infiltrated the underlying tissue to appear over the skin with central zone of necrosis and surrounding erythematous induration. (Fig. 1) Incisional biopsy from mucosal surface of the lesion revealed well to moderately differentiated squamous cell carcinoma. The neck was clinically N0 which similarly correlated following contrast CT scan of the neck. The surgical planning for the tumour was wide excision, SOND (Supra Omohyoid neck dissection) and reconstruction of the defect with FRAFF. Wide excision of the primary lesion was carried out along with the SOND on the affected side.The neck dissection was done with extreme care to preserve the facial vessels when dissecting level IB. Dissection of the submandibular gland was done by safely ligating the submandibular branches of the facial artery to the gland and preserving the whole artery along its course on the posterior aspect of the gland. The right lip commissure involving lateral one third of the lower lip, part of skin in the cheek along with underlying part of cheek musculature, inner buccal and labial mucosa, gingivo-buccal sulcus and gingiva along with the alveolar bone sparing the lower border of the mandible were resected. The size of the primary defect following tumour resection was 5.2x4.8x3.7 cm. The reconstruction of the surgical defect was done with FRAFF. On completion of the reconstruction the flap looked well perfused and healthy. The flap was monitored clinically at an hourly basis. By 4 th -5 th hours mild ooze from the drain port had become noticeable along with marked oedema in the flap. (Fig. 2) On the 8 th hour post operatively there was dusky appearance of the flap, along with oedema. On needle prick there was dark blood ooze from the flap and therefore the decision for re exploration was taken suspecting venous compromise. On re exploration a huge hematoma was noticed under the flap, around the anastomosis and along the IJV. The clots were delicately removed. The adjoining areas were irrigated with warm saline, and venous and arterial anastomoses were evaluated. There were no clots in the vein and normal flow through the artery was seen. Acland's "milking" test was performed. In the test the artery was occluded with a forceps immediately caudal to anastomosis and then with a second forceps artery was occl...

show abstract

“…A survey conducted among microsurgeons from 95 centers in North America revealed that 90% of microsurgeons use monitoring devices for monitoring of free-tissue transfer. 3 Several techniques were reported, but there is still no consensus as to which will eventually become the standard accepted method.…”

mentioning

confidence: 99%

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

et al. 2002

View full text Add to dashboard Cite

In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome.

show abstract

Free flap monitoring: A review of current practice

Cited by 102 publications

References 14 publications

A comparison of pulse oximetry and laser Doppler flowmetry in monitoring sequential vascular occlusion in a rabbit ear model

A comparison of pulse oximetry and laser Doppler flowmetry in monitoring sequential vascular occlusion in a rabbit ear model

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

Contact Info

Product

Resources

About