Durnig P, Meier M, Reichert B
Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Klinikum Nürnberg Süd.
Handchir Mikrochir Plast Chir. 2008 Dec;40(6):392-9. doi: 10.1055/s-2008-1039161. Epub 2008 Dec 8.
PURPOSE/BACKGROUND: The risk of total flap loss after free microvascular tissue transfer is estimated to be between 2 and 6 %. According to the literature the main reason for flap loss is thrombosis of the anastomosis. The percentage of successful revision is decreasing depending on the time period between circulatory failure and its detection. For this reason postoperative monitoring has been developed. The focus of interest was the question if there are generally accepted principles for postoperative flap monitoring.
PATIENTS, MATERIALS AND METHOD: This research focused on finding standards for postoperative monitoring methods. Further topics of interest were surgical technique, anticoagulation, decision criteria for revision, the use of technical support and monitoring plans. Therefore all 150 members of the Society for Microsurgery in the German-speaking countries Austria, Germany and Switzerland received a questionnaire.
74 out of 150 surgeons answered and returned the questionnaire (49.3 %). Only a minority of responders use couplers routinely for anastomosis with only 10.3 %, whilst 89.7 % use conventional anastomosis. 65.6 % of the surgeons use heparin for the anastomosis, 45.6 % of them systemically. 44.1 % continue a systemic use of heparin postoperatively. We could show that monitoring and decision for revision is done for clinical reasons. Altogether only 29.4 % use technical support for monitoring. The Doppler US is used most often by 16.2 % for routine use, followed by licox pO (2) sensor by 5.9 % and the thermo-sensor by 4.4 %. Most common postoperative interval for monitoring is (43.1 %): every hour until day 3, every second hour until day 5 and decreasing intervals until discharge from the hospital.
A well-working anastomosis is obligatory for successful free microvascular tissue transfer. Most of the surgeons perform hand-made anastomosis. We could show that monitoring and decision for revision is mainly for clinical reasons. Most commonly in use for technical support was the Doppler US method for accessing flap viability.
目的/背景：游离微血管组织移植后皮瓣完全坏死的风险估计在2%至6%之间。根据文献，皮瓣坏死的主要原因是吻合口血栓形成。成功修复的百分比会随着循环衰竭与其被发现之间的时间间隔而降低。因此，术后监测应运而生。人们关注的焦点是是否存在被普遍接受的术后皮瓣监测原则。
患者、材料与方法：本研究着重于寻找术后监测方法的标准。其他感兴趣的主题包括手术技术、抗凝、修复的决策标准、技术支持的使用以及监测计划。因此，向德语国家奥地利、德国和瑞士的显微外科学会的所有150名成员发放了问卷。
150名外科医生中有74人回复并返回了问卷（49.3%）。只有少数受访者常规使用吻合器进行吻合，仅占10.3%，而89.7%使用传统吻合方法。65.6%的外科医生在吻合时使用肝素，其中45.6%全身使用。44.1%的医生在术后继续全身使用肝素。我们发现，监测和修复决策是基于临床原因进行的。总共只有29.4%的人使用技术支持进行监测。多普勒超声最常被16.2%的人用于常规监测，其次是licox pO₂传感器占5.9%，热传感器占4.4%。最常见的术后监测间隔是（43.1%）：术后第1天每小时监测一次，第3天前每隔1小时监测一次，第5天前每隔2小时监测一次，直至出院监测间隔逐渐延长。
良好的吻合对于游离微血管组织移植的成功至关重要。大多数外科医生进行手工吻合。我们发现，监测和修复决策主要基于临床原因。用于评估皮瓣活力的技术支持中最常用的是多普勒超声方法。
