Prospective analysis of flap perfusion by measuring capillary glucose level in flaps

Sharma, Mukesh Kumar; Ete, Geley; Chaturvedi, Gaurav; Barreto, Elvino; Doss, Kingsly Paul Meetper

doi:10.1007/s00238-018-1464-6

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Theoretically, under the state of poor perfusion related to venous insufficiency, glucose supply could be disrupted, whereas its physiological consumption would occur steadily, resulting in a rapid decrease in the glucose level in the flap tissue. The efficacy and reliability of BGM for assessing flap perfusion and identifying the development of venous insufficiency have been reported in several experimental and clinical studies 5–8,10,12,13 . Accordingly, several studies have suggested the active application of BGM for flap monitoring and its routine use 14,15 .…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy and reliability of BGM for assessing flap perfusion and identifying the development of venous insufficiency have been reported in several experimental and clinical studies. [5][6][7][8]10,12,13 Accordingly, several studies have suggested the active application of BGM for flap monitoring and its routine use. 14,15 However, despite these strengths, its use in clinical practice has been relatively limited.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Blood glucose measurement (BGM) for flap monitoring was first introduced in 2010 by Sakakibara et al 5 Subsequently, several clinical and experimental studies have been conducted to evaluate its clinical efficacy and accuracy. [6][7][8][9][10] Hara et al 6 suggested a cutoff value for the BGM of 62 mg/dL, at which sensitivity and specificity were 88% and 82%, respectively. Bashir et al 8 demonstrated that the flap BGM had a high diagnostic accuracy for venous congestion.…”

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confidence: 99%

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Selective Application of Blood Glucose Monitoring After Free Flap Surgery

Kim

Lee

2023

Ann Plast Surg

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BackgroundFor free-flap monitoring, physical examination still serves as the criterion standard. Blood glucose measurement (BGM) has been suggested to be useful in identifying flap perfusion status. Nonetheless, its routine use may not be cost-effective in real-world settings. This study aimed to share the experiences of using BGM for flap monitoring and suggest its potential indications.MethodsOf cases of free flap reconstruction conducted between March 2017 and May 2021, those using BGM for flap monitoring were reviewed. Blood glucose measurement was selectively conducted for the following specific situations, which included encountering a flap showing a reddish discoloration and/or rapid capillary refilling time in the immediate postoperative period, monitoring discolored flaps after conducting a salvage operation, and conducting bloodletting therapy for salvaging congestive flaps. The clinical course and outcomes were evaluated.ResultsOf a total of 203 cases, 35 used BGM for flap monitoring in addition to clinical examination. In 29 cases, BGM was performed to distinguish early hyperemia from true venous insufficiency. All flaps showed BGM greater than 60 mg/dL with a mean value of 115.42, suggesting early hyperemia, and had uneventful postoperative courses. In 3 cases with already discolored flaps after a salvage operation, BGM was conducted 4 times serially every 3 hours and showed a mean value of 81.6 mg/dL with increasing trends. The flaps recovered completely. In the other 3 cases requiring bloodletting therapy, BGM was conducted an average of 11 times at a median interval of 7 hours. The bloodletting therapy was terminated with reference to the value of BGM when it showed greater than 60 mg/dL while the therapy was on hold. All flaps were successfully salvaged except one showing partial necrosis.ConclusionsBlood glucose measurement may be helpful in assessing flap perfusion and decision making in certain clinical situations and may be useful as an ancillary tool for flap monitoring. Selective application of BGM may contribute to achieving optimal outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Selective Application of Blood Glucose Monitoring After Free Flap Surgery

Kim

Lee

2023

Ann Plast Surg

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“… 3 In another study by Sharma et al, using an ROC curve, the cut-off value for flap capillary sugar level was 61 mg/dL, with a sensitivity of 93% and a specificity of 80%. 4 However, all these studies evaluated the CBG for free flap, as well as of pedicled flap and estimated the cut-off values as combined results. In an attempt to obtain more accurate monitoring method for flap congestion Karakawa et al 5 measured the ratio of blood glucose level change (RBGC) within the free flap in 36 free tissue transfers.…”

Section: Discussionmentioning

confidence: 99%

“…However, the horizon of capillary sugar monitoring as a standard test for free flap monitoring has been limited due to two reasons. Firstly, after extensive literature search, we found that in all those studies evaluating free flap blood glucose levels for postoperative monitoring, 1 2 3 4 5 diabetic patients have always been excluded. Secondly, the glucose levels of study patients were also not recorded in the postoperative period.…”

Section: Introductionmentioning

confidence: 99%

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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Predictors, management and prognosis of initial hyperemia of free flap

Bae,

Lee

2024

Sci Rep

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In free flap operation, temporary hyperemia of the transferred flaps can often be encountered in the early postoperative period, appearing reddish and rapid capillary refilling time, which mimics venous congestion. This study aimed to investigate the factors associated with the development of hyperemia and evaluate clinical course. Consecutive patients who underwent free flap-based reconstruction between December 2019 and October 2021 were reviewed. Independent risk factors associated with its development were assessed. Flap showing initial hyperemic features were assessed using flap blood glucose measurement (BGM). If it showed over 60 mg/dL, they were closely observed without management. Their clinical outcomes were evaluated. In total, 204 cases were analyzed, of which 35 (17.2%) showed initial hyperemia. Multivariable analyses showed that using thoracodorsal artery perforator flaps and muscle containing flaps (musculocutaneous/muscle-chimeric flaps) and conducting end-to-end arterial anastomosis (vs. end-to-side) were independent predictors. All cases with initial hyperemia showed over 60 mg/dL in BGM. The phenomenon resolved spontaneously within 6.9 h averagely. Overall perfusion-related complications developed in 10 (4.9%) cases, which rate did not differ between the two groups. Several factors might be associated with the development of initial hyperemia after free flap surgery. With proper assessment, this condition can be successfully managed without unnecessary intervention.

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Prospective analysis of flap perfusion by measuring capillary glucose level in flaps

Cited by 4 publications

References 14 publications

Selective Application of Blood Glucose Monitoring After Free Flap Surgery

Selective Application of Blood Glucose Monitoring After Free Flap Surgery

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

Predictors, management and prognosis of initial hyperemia of free flap

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