Tissue Oxygen Tension Measurement for Monitoring Musculocutaneous and Cutaneous Flaps

Abstract

In pigs, latissimus dorsi musculocutaneous island flaps and buttock skin island flaps were raised. Subcutaneous (PscO2) and intramuscular oxygen tension (PimO2) were measured using a non-heated needle electrode before, during and after repeated occlusion of the supplying artery or the draining vein. During arterial and venous occlusion, the tissue oxygen tension in the musculocutaneous flap dropped rapidly. A plateau was reached after 15 min. After arterial occlusion the mean value was 20 mmHg (SEM = +/- 5 mmHg, N = 6) in the subcutis and 16 mmHg in the muscle (SEM = +/- 4 mmHg, N = 10). After venous occlusion the mean value was 11 mmHg (SEM = +/- 3 mmHg, N = 6) in the subcutis. In the skin flap the drop of PscO2 was slower, and after 30 min of arterial occlusion the mean value was 29 mmHg (SEM = +/- 9 mmHg, N = 6). This study has shown that tissue oxygen tension measurement can be used as a sensitive indicator of acute impairment of the supplying vessels in island flaps. The method seems to have potential for monitoring free tissue transfers. A comparable decrease in PscO2 was found for arterial and venous impairment.

Modern adjuncts and technologies in microsurgery: An historical and evidence‐based review

“…Recent techniques reported for postoperative monitoring include pulse oximetry,79–91 perfusion photoplethysmography,92, 93 surface temperature measurement,94, 95 fluorometry,95–102 microdialysis,103–106 ultrasound,79, 107–109 implanted (Cook‐Swartz) Doppler probes (see Fig. 2),110–119 laser Doppler flowmetry,120–126 impedance plethysmography,127–129 confocal microscopy,130 nuclear medicine,131–133 subcutaneous pH measurement,95, 134–136 hydrogen clearance,137, 138 externalization of part of a buried flap,122, 139 and white light spectrometry 123…”

Microvascular Tissue Oxygenation and Oxidative Metabolism Changes in the Pedicled Latissimus Dorsi Muscle During Graded Hypoxia: Correlation Between Near Infrared and 31P Nuclear Magnetic Resonance Spectroscopy

“…Hypoxia is defined as a reduction in tissue PO 2 to levels insufficient to maintain cellular function, metabolism, and morphologic structure. The association between tissue PO 2 and tissue viability have been studied previously [4,5,7]. Additionally, at lower arterial PO 2 levels, blood pH has a pronounced effect on the oxyhemoglobin dissociation curve.…”

“…The analogous-to-digital (A/D) and inputoutput (I/O) converter board converts the detected analogous signals into digitals for further data processing (interface between software and device subunits). and play a key role in the pathophysiologic cascade after surgical ischemia [1][2][3][4][5][6][7]. Under these conditions, tissue injury is attributable to compromised microvascular blood flow, ischemia, tissue hypoxia, and the resulting consequences [1][2][3].…”

“…Recent studies have shown that ischemia and reperfusion induce impairment in microvascular tissue oxygenation and result in tissue injury (necrosis, apoptosis) [2][3][4][5][6][7]. This may reflect the oxygen requirement of the tissue and its sensitivity to hypoxia.…”

Monitoring of Free Flaps with Combined Tissue Spectrophotometry and Laser Doppler Flowmetry in an Animal Experimental Model

“…[5][6][7] Traditionally, free tissue transfers are monitored clinically by evaluation of color, capillary response, and bleeding after needle prick. An often-used regime includes evaluation every hour during the first 24 postoperative hours, 8 but other methods of monitoring have shown that vascular compromise may be detected earlier. 9 Flap monitoring should ideally be harmless to patient and flap, reliable and accurate, easy to use and interpret, and give continuous information about the condition of the flap.…”