Pure Muscle Transfers Can Be Monitored by Use of Microdialysis

Abstract

Most of the methods available for postoperative monitoring of free transfers depend on an accessible skin island. Monitoring of muscle transfers without skin islands represents a challenge. The aim of this study was to describe the experiences after clinical monitoring of free muscle transfers by the use of microdialysis. The charts of 75 free muscle transfers monitored with microdialysis were evaluated with special emphasis on whether or not complications were predicted by the monitoring system. In 16 of the 75 cases, an ischemic trend was seen. In five of these cases, the ischemic trend was reversed without surgical revascularization. In the remaining 11 cases (14.7%), further ischemic trends were seen, and surgical revision with revascularization was needed for transfer salvage. Six of the 11 transfers were subsequently saved. None of the remaining five transfers were lost due to neglected ischemia. The microdialysis system did not exhibit any negative or positive false alarms. No damage to the muscle flap was experienced while performing the monitoring procedures. Microdialysis is a reliable and safe monitoring method for surveillance of free muscle transfers.

Intraosseous microdialysis for bone free flap monitoring in head and neck reconstructive surgery: A prospective pilot study

“…The distribution of lactate values that we obtained in fibula and iliac crest free flaps does not corroborate the soft tissue alert values. Similarly, we found a mean glucose level of 2.02 mmol/L during the monitoring period; even though this is higher than the alert value described by Birke‐Sørensen et al () for muscle free flaps, it is almost three times lower than the value of 6 mmol/L considered by Setälä et al () to be the normal value in soft tissue. Forty percent of the glucose values recorded in our study were between 0 and 1 mmol/L, which is considered as a Level 1 alert in muscle free flaps (Figure A–C).…”

“…Our present results demonstrate that the microdialysis reference values for soft tissues cannot be applied to bone. For example, a lactate concentration above 10 mmol/L corresponds to a Level 1 alert, and 15 mmol/L is considered to be critical in soft tissues (Birke‐Sørensen et al, ). The distribution of lactate values that we obtained in fibula and iliac crest free flaps does not corroborate the soft tissue alert values.…”

Current Evidence for Postoperative Monitoring of Microvascular Free Flaps

“…91,92 Similar to the implantable Doppler probes, it is potentially useful in buried flaps and cutaneous flaps that are difficult to examine. 93,94 Edsander-Nord et al 84 have illustrated the sensitivity of this technique by showing that microdialysis can detect a difference in metabolism between free and pedicled transverse rectus abdominis myocutaneous flaps, and between zones I and II of the same group of flaps. 85 Sorensen 95 successfully used microdialysis in buried free jejunal transfers to identify flap compromise early and salvage 2 such flaps.…”

Direct comparison of postoperative monitoring of free flaps with microdialysis, implantable cook‐swartz Doppler probe, and clinical monitoring in 20 consecutive patients

“…It has been described as simple and safe for buried flaps . In the literature, problems with keeping the catheter in place and dysfunction of the microdialysis pump or catheter or the bedside analyzer has been described and were observed in our department . Of the 22 flaps monitored with microdialysis, we experienced a mean 1.95 (max, min, 0–17) level 1 alarms on 10 flaps, 1.36 mean (max, min, 0–1) level 2 alarms in 3 flaps, and 9 flaps without alarm.…”

“…Microdialysis was used as standard monitoring modality in the department proior to the study and indicating for reoperation. Glucose < 1 mmol/L or Lactate > 10 mmol/L or ischemia trend was indication to direct contact the surgeon on call after the algorithm in Birke‐Sørensen et al and Nielsen et al A capillary refill between 2 and 4 seconds was considered to be normal, <2 seconds considered brisk and more than 4 seconds delayed.…”