Steele Matthew H
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
Ann Plast Surg. 2011 May;66(5):540-5. doi: 10.1097/SAP.0b013e31820909f9.
Early recognition of threatened free-flap failure is paramount to flap salvage. A noninvasive, reproducible, sensitive monitoring tool would be a useful adjunct to clinical examination. The purpose of this study was to examine outcomes using a near-infrared spectroscopy (NIRS) tissue oximeter for postoperative flap monitoring. A total of 128 free flaps were performed in 113 patients over a 3 year period. The patients were divided into 2 cohorts: conventional monitoring (group 1) and conventional monitoring plus NIRS oximetry (group 2). Overall flap survival was 90.6% in group 1 and 98.7% in group 2 (P = 0.05). Overall survival of threatened flaps was 0% (0/5) in the conventional group and 87.5% (6/7) in the oximeter group, P = 0.005. Salvage of operated flaps was significantly improved in group 2: 0% (0/4) in group 1 versus 100% (3/3) in group 2, P = 0.03. The sensitivity, specificity, and predictive values for detecting threatened flap loss were 100%. The NIRS tissue oximeter is a highly reliable, sensitive, and specific, noninvasive method for postoperative free tissue transfer monitoring.
早期识别游离皮瓣失败的先兆对于挽救皮瓣至关重要。一种非侵入性、可重复且敏感的监测工具将是临床检查的有用辅助手段。本研究的目的是使用近红外光谱（NIRS）组织血氧饱和度测定仪对术后皮瓣进行监测并检查结果。在3年期间，113例患者共进行了128例游离皮瓣手术。患者被分为2组：传统监测组（第1组）和传统监测加NIRS血氧饱和度测定组（第2组）。第1组皮瓣总体存活率为90.6%，第2组为98.7%（P = 0.05）。传统组中出现问题的皮瓣总体存活率为0%（0/5），血氧饱和度测定组为87.5%（6/7），P = 0.005。第2组中手术皮瓣的挽救情况显著改善：第1组为0%（0/4），第2组为100%（3/3），P = 0.03。检测皮瓣出现问题的敏感性、特异性和预测值均为100%。NIRS组织血氧饱和度测定仪是一种用于术后游离组织移植监测的高度可靠、敏感且特异的非侵入性方法。
