Mechanical Leeching with Venocutaneous Fistula and Monitoring with Near-infrared Spectroscopy

Bank, Jonathan; Beederman, Maureen; Shore, Adam; Song, David H.

doi:10.1097/gox.0b013e3182aa8752

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Tissue oximetry is a noninvasive yet sensitive, reliable, and easy to implement flap monitoring modality. 7 Increased salvage rate of flaps monitored with tissue oximetry has been demonstrated in the literature. We present a unique case of a pediatric trauma patient where real-time remote monitoring and ViOptix alarming alerting the microsurgical team to the early development of a potentially catastrophic complication.…”

Section: Resultsmentioning

confidence: 96%

“…6 Anastomotic thrombosis is a devastating and at times unavoidable potential complication of free flap microvascular surgery. 7 Earlier detection of problems with more timely intervention prevents the progression to microvascular thrombosis. 8 The ViOptix tissue oximeter measures tissue oxygen saturation using the near-infrared spectroscopy technology.…”

Section: Discussionmentioning

confidence: 99%

“…5 The wavelength for near-infrared laser light is 700 to 100 nm. 7 Near-infrared light is scattered due to the heterogeneous nature of human tissue. 3 As hemoglobin selectively absorbs the near-infrared light, there is variation in the reflected scatter intensity and this is detected by the device.…”

Section: Discussionmentioning

confidence: 99%

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Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review

Kozusko

Gbulie

2018

J Reconstr Microsurg Open

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).Microsurgical techniques have allowed the performance of complex reconstructive endeavors with a good rate of success. Compromise of the arterial or venous anastomosis is commonly responsible for free flap failure. This most frequently occurs during the first 48 hours postoperatively. 1 The early detection of microvascular complications improves flap salvage rate. 2 Detecting the complication alone is insufficient if it is only detected after salvage is no longer feasible. Therefore, ideal flap monitoring modalities should detect potentially catastrophic events early, allowing a microsurgeon an opportunity to salvage the flap.Conventional free flap monitoring includes assessing the color, turgor, temperature, capillary refill, and arterial and venous Doppler signals with a handheld Doppler probe. The potential drawback with conventional monitoring techniques is that they may only detect the problem after it has progressed Keywords ► microsurgeon ► tissue oximetry ► near-infrared spectroscopy AbstractBackground Microvascular compromise from arterial or venous occlusion is a common cause of free flap failure. The salvage rate following a microvascular compromise is dependent on detecting the problem early and intervening quickly. Methods The ViOptix tissue oximeter measures tissue oxygen saturation using the nearinfrared spectroscopy technology. The ViOptix device has an alarm capability to warn of potential compromise to tissue perfusion. The tissue oximetry readings are visible on the bedside monitor and are relayed to a webpage link, which is accessible on a personal computer or mobile device, allowing real-time monitoring. This article presents a case where real-time monitoring allowed almost immediate detection of inadvertent pedicle compromise allowing flap salvage by repositioning without surgical intervention. Results In the case presented, the patient's nurse inadvertently positioned a pillow under the location of the vascular pedicle likely causing microvascular compression. The ViOptix reading dropped and for this reason the nurse contacted the Plastic Surgery team. The drop was confirmed remotely and the flap was urgently evaluated in person. Once the pillow was removed, the ViOptix readings normalized and Doppler signals strengthened in the flap. Discussion While tissue oximetry monitoring does not by itself ensure flap survival, it provides critical information than conventional flap monitoring would allow giving the microsurgeon the opportunity to make a quicker decision. ViOptix tissue oximeters are able to detect vascular compromise even before conventional clinical symptoms are present. Alas in several cases by the time clinical symptoms develop the flap may be beyond salvage.

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review

Kozusko

Gbulie

2018

J Reconstr Microsurg Open

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Free flap salvage from venous thrombosis by creation of a venocutaneous fistula: Case report and review of the literature

et al. 2019

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Background Venous congestion is the most frequently reported complication of free flap tissue transfer in head and neck patient with cancer. Numerous methods are utilized and prompt correction is necessary to prevent flap failure. Methods A 77‐year‐old woman underwent oral cavity resection and neck dissection for squamous cell carcinoma followed by radial forearm free flap for reconstruction. Three days later, the flap became congested and surgical exploration revealed extensive venous thrombosis throughout the free flap venous system and internal jugular vein. The flap vein was evacuated and flowing, and a venocutaneous fistula was created thereafter. Results Venocutaneous fistula resulted in flap decongestion and successful salvage. The patient was discharged from the hospital with no further flap or surgical complications. Conclusion When anatomical revision of the venous anastomosis is not feasible in a venous‐congested free flap, the creation of a venocutaneous fistula should be considered as a viable option for salvage.

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Discussion: Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect

Inbal

Song

2016

Plastic &Amp; Reconstructive Surgery

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Mechanical Leeching with Venocutaneous Fistula and Monitoring with Near-infrared Spectroscopy

Cited by 3 publications

References 11 publications

Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review

Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review

Free flap salvage from venous thrombosis by creation of a venocutaneous fistula: Case report and review of the literature

Discussion: Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect

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