Red or white? Use of high colour-rendering index, light-emitting diodes in monitoring of free flaps of the head and neck

Genechten, Maarten Van; Rahmel, B.; Batstone, Martin

doi:10.1016/j.bjoms.2015.04.020

Cited by 6 publications

(4 citation statements)

References 1 publication

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“…Previously, complementary methods have been proposed to account for some of CE-related shortcomings. While Urken et al proposed the exteriorization of a well-vascularized FF segment in buried head and neck defect coverages, van Genechten suggested the use of high colorrendering index, light-emitting diodes to overcome poor lighting during CE of intraoral FFs (30,35). Such modifications of the rudimentary CE may increase its accuracy and widen its applicability; however, further age-adjusted configurations are required.…”

Section: Clinical Examinationmentioning

confidence: 99%

Postoperative free flap monitoring in reconstructive surgery—man or machine?

Knoedler

Hoch²,

Huelsboemer³

et al. 2023

Front. Surg.

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Free tissue transfer is widely used for the reconstruction of complex tissue defects. The survival of free flaps depends on the patency and integrity of the microvascular anastomosis. Accordingly, the early detection of vascular comprise and prompt intervention are indispensable to increase flap survival rates. Such monitoring strategies are commonly integrated into the perioperative algorithm, with clinical examination still being considered the gold standard for routine free flap monitoring. Despite its widespread acceptance as state of the art, the clinical examination also has its pitfalls, such as the limited applicability in buried flaps and the risk of poor interrater agreement due to inconsistent flap (failure) appearances. To compensate for these shortcomings, a plethora of alternative monitoring tools have been proposed in recent years, each of them with inherent strengths and limitations. Given the ongoing demographic change, the number of older patients requiring free flap reconstruction, e.g., after cancer resection, is rising. Yet, age-related morphologic changes may complicate the free flap evaluation in elderly patients and delay the prompt detection of clinical signs of flap compromise. In this review, we provide an overview of currently available and employed methods for free flap monitoring, with a special focus on elderly patients and how senescence may impact standard free flap monitoring strategies.

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Section: Clinical Examinationmentioning

confidence: 99%

Postoperative free flap monitoring in reconstructive surgery—man or machine?

Knoedler

Hoch²,

Huelsboemer³

et al. 2023

Front. Surg.

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“…Therefore, experience and expertise in interpreting the variety of warning symptoms for flap failure are crucial. Further, the specific light source used to inspect the FFF and dark skin tone represent additional pitfalls when evaluating FFF failure ( 137 , 139 , 140 ). Monitoring of buried FFFs is even more challenging as there is no direct access postoperatively to the bony segment and the use of ADS is commonly limited to superficial vessels ( 141 ).…”

Section: Progress In the Postoperative Period – The Advent Of Modern ...mentioning

confidence: 99%

From bench to bedside – current clinical and translational challenges in fibula free flap reconstruction

Baecher,

Hoch,

Knoedler

et al. 2023

Front. Med.

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Fibula free flaps (FFF) represent a working horse for different reconstructive scenarios in facial surgery. While FFF were initially established for mandible reconstruction, advancements in planning for microsurgical techniques have paved the way toward a broader spectrum of indications, including maxillary defects. Essential factors to improve patient outcomes following FFF include minimal donor site morbidity, adequate bone length, and dual blood supply. Yet, persisting clinical and translational challenges hamper the effectiveness of FFF. In the preoperative phase, virtual surgical planning and artificial intelligence tools carry untapped potential, while the intraoperative role of individualized surgical templates and bioprinted prostheses remains to be summarized. Further, the integration of novel flap monitoring technologies into postoperative patient management has been subject to translational and clinical research efforts. Overall, there is a paucity of studies condensing the body of knowledge on emerging technologies and techniques in FFF surgery. Herein, we aim to review current challenges and solution possibilities in FFF. This line of research may serve as a pocket guide on cutting-edge developments and facilitate future targeted research in FFF.

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“…For this reason, Van Genechten et al have used high colorrendering index, LED light sources. 19 For buried flaps in which pedicle lies superficially, acoustic Doppler assessment may be a reliable means of assessing perfusion. The frequency of clinical monitoring in the early postoperative period varies between centers, but clinical flap checks are commonly done every 2 to 4 hours for the first 2 to 3 days postoperatively.…”

Section: Clinical Monitoringmentioning

confidence: 99%