Monitoring techniques for the detection of flow failure in the postoperative period

Neligan, PC

doi:10.1002/micr.1920140306

Cited by 69 publications

(38 citation statements)

References 23 publications

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“…The evaluation of total blood flow in limbs has been carried out using several techniques such as oscillometry, plethysmography (based on pressure or volume measurements) and ultrasonic and x-ray techniques, which have also been used for flow studies within single blood vessels [9,10], isotope clearance and microsphere techniques [11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Laser Doppler Evaluation of Microcirculation Behaviour during an Ischaemia-Reperfusion Injury

Rocca¹,

Giavaresi²,

Fini³

et al. 1998

Eur Surg Res

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Laser Doppler flowmetry (LDF) was tested in an experimental ischaemic model on rat limbs to evaluate the degree of ischaemia and to find a possible correlation with values obtained with this device and prognosis. Under general anaesthesia, 40 Wistar rats were submitted to 4 h and 30 min of ischaemia of the left hind limb. Ten rats formed the control group (group 1). Two enzymes, native superoxide dismutase (SOD) and SOD modified with polyethylene glycol, were employed in 15 rats each (groups 2 and 3). Data were collected by means of LDF both in the sole and muscles before ischaemia (steady state), during ischaemia and at the beginning of reperfusion, and only in the sole after 1 h of reperfusion. A range of predictive (95%) perfusion values (PU) for limb healing or necrosis was identified at the beginning of reperfusion. During ischaemia, PU changed from 0 to 10, both in the sole and in the muscle. A three-factor ANOVA (site, group, time) did not show interaction of these factors with PU (F = 1.655; p = 0.195), even if every single effect was significant (p < 0.0005). A two-factor ANOVA (group, time) showed a significant interaction of these factors with PU (F = 4.079; p = 0.019). The logistic regression between the reperfusion PU of each site and the survival of the limb was observed at the beginning and after 1 h of reperfusion in the sole only. Furthermore, a correlation between sole and muscle PU at the steady state and at the beginning of the reperfusion period was observed. The results showed the effectiveness of LDF, which can be considered a quite reliable tool to evaluate the degree of ischaemia and to have a good correlation with prognosis in this kind of experiments.

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Section: Discussionmentioning

confidence: 99%

Laser Doppler Evaluation of Microcirculation Behaviour during an Ischaemia-Reperfusion Injury

Rocca¹,

Giavaresi²,

Fini³

et al. 1998

Eur Surg Res

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“…27,28 Most of these methods have technical or validity problems restricting their wide adaptation, and few of them (the buried Doppler probe notably excepted) can examine buried flaps. 5,6,[27][28][29][30][31] In our study, we examined the potential use of magnetic resonance imaging (MRI) to assess skeletal muscle circulation. MRI is a relatively new, noninvasive diagnostic tool in which a tomographic cross-sectional image of tissue can be visualized and analyzed.…”

Section: Microsurgery 17:306-312 1996mentioning

confidence: 99%

Magnetic resonance imaging detection of vascular occlusion of a pedicled muscle flap

et al. 1996

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Contrast-enhanced magnetic resonance imaging (MRI) can be a highly sensitive monitor of tissue blood perfusion. This technique has been used to assess blood flow through liver, kidney, and certain tumors, but has not been widely applied to the study of skeletal muscle circulation. In our study, we used a novel scanning software to obtain contrast-enhanced T2*-weighted gradient echo MRI images of pedicled quadriceps muscle flaps in rabbits in order to study images of arterial, venous, and arterio-venous occlusion. We administered an intravenous bolus of gadoteridol contrast agent at the initiation of scanning, which produces a decrease in T2*-signal and improves the sensitivity of measuring blood perfusion. Within 30 seconds of MRI scanning, control flaps with intact pedicles exhibited a rapid decrease in T2*-signal intensity, indicating adequate perfusion of blood through muscle tissue; however, occluded pedicled flaps showed no significant change in signal intensity, indicating lack of blood perfusion. Differences in signal intensities as measured by MRI between occluded and control flaps were statistically significant (P < 0.05). Selective vascular occlusion of either artery alone, or both artery and vein were detected within 15 minutes, whereas selective venous occlusion could be detected after 2 hours. We conclude that MRI has the ability to assess skeletal muscle perfusion, and is capable of noninvasively evaluating a cross-section of tissue in both superficial and buried flaps. MRI, therefore, may have the potential for evaluating perfusion in muscle flaps (including buried flaps), and other disorders of muscle circulation such as compartment syndrome.

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“…In fair-skinned patients, cyanosis is usually the first clinically observed indication of compromised skin perfusion. Venous compromise is more common than arterial failure in microvascular free tissue transplantation and is also noted as a cause of failure of pedicle flaps [1][2][3][4][5][6][7]. Compromised skin perfusion is sometimes not truly appreciated clinically until epidermolysis occurs.…”

Section: Introductionmentioning

confidence: 99%

Assessment and interpretation of capillary refill in clinical evaluation of flap perfusion are subject to a lag time

Sandberg

Tzarnas

2012

Eur J Plast Surg

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Background A reliable assessment of the vascular perfusion of flaps in the postoperative period can be challenging. Clinical assessment of capillary refill is an integral component of this evaluation. Methods Ten consecutive patients undergoing abdominoplasty were studied. The resected pannus was brought to the back table and assessed for capillary refill every 5 min. The time elapsed from complete resection until the last refill was observed and recorded. Results Our findings somewhat surprisingly show that capillary refill continues for an average of 75 min in an abdominoplasty specimen after its complete separation from its blood supply. Conclusion We believe that capillary refill is testing the patency of the capillary microcirculation rather than the actual perfusion of the flap. This limits the value of capillary refill in the clinical evaluation of flaps. Level of Evidence: Level III, diagnostic study.

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Monitoring techniques for the detection of flow failure in the postoperative period

Cited by 69 publications

References 23 publications

Laser Doppler Evaluation of Microcirculation Behaviour during an Ischaemia-Reperfusion Injury

Laser Doppler Evaluation of Microcirculation Behaviour during an Ischaemia-Reperfusion Injury

Magnetic resonance imaging detection of vascular occlusion of a pedicled muscle flap

Assessment and interpretation of capillary refill in clinical evaluation of flap perfusion are subject to a lag time

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