Henault B, Pluvy I, Pauchot J, Sinna R, Labruère-Chazal C, Zwetyenga N
Service de chirurgie maxillo-faciale, plastique et reconstructrice, centre hospitalier universitaire de Dijon, boulevard de Lattre-de-Tassigny, 21079 Dijon cedex, France.
Service de chirurgie orthopédique, traumatologique et plastique, centre hospitalier universitaire de Besançon, boulevard Alexandre-Fleming, 25000 Besançon, France.
Ann Chir Plast Esthet. 2014 Feb;59(1):15-21. doi: 10.1016/j.anplas.2013.08.001. Epub 2013 Sep 26.
It is reported that the salvage rate of free flaps is inversely related to the time interval between the onset of pedicle impairments and their clinical recognition. Monitoring of free flaps is therefore of major importance and clinical monitoring remains the most used technique because of lack of low-cost and non-invasive techniques. The authors suggested an efficient, simple and cheap technique to detect early thrombotic events in monitoring free flaps with skin paddle.
In this multicentre prospective study, measurements of capillary glucose and lactate in the flaps were done. These parameters were compared to standardized clinical monitoring during the first five days. Two sets of data (eventful versus uneventful postoperative period) were analyzed to define the thresholds of lactate and glucose values for diagnosis of pedicle complications, and to establish parameters for this screening test.
Over a period of 19 months, 37 patients were included. With 5 pedicle impairments, complication thresholds were defined as lactate ≥ 6.4 mmol L(-1) and glucose ≤ 3.85 mmol L(-1), in order to obtain a sensitivity of 98.5% and a specificity of 99.5% for the test. Modifications of capillary glucose and lactate measurements appeared in average 5.7 hours earlier than clinical symptoms in pedicle impairments. The mean cost of a five-day monitoring was about 90 USD.
This simple and cheap technique could be used as a routine technique in monitoring free flaps to improve safety of this reconstructive technique.
据报道，游离皮瓣的挽救率与蒂部损伤发生至临床识别的时间间隔呈负相关。因此，游离皮瓣的监测至关重要，由于缺乏低成本且非侵入性的技术，临床监测仍是最常用的技术。作者提出了一种高效、简单且廉价的技术，用于在监测带皮肤桨叶的游离皮瓣时检测早期血栓形成事件。
在这项多中心前瞻性研究中，对皮瓣中的毛细血管葡萄糖和乳酸进行了测量。在头五天内，将这些参数与标准化临床监测进行比较。分析两组数据（术后情况良好与不佳），以确定用于诊断蒂部并发症的乳酸和葡萄糖值阈值，并建立该筛查试验的参数。
在19个月的时间里，纳入了37例患者。出现5例蒂部损伤，并发症阈值定义为乳酸≥6.4 mmol/L和葡萄糖≤3.85 mmol/L，以使该试验的灵敏度达到98.5%，特异性达到99.5%。在蒂部损伤中，毛细血管葡萄糖和乳酸测量值的变化平均比临床症状早5.7小时出现。为期五天的监测平均费用约为90美元。
这种简单且廉价的技术可作为监测游离皮瓣的常规技术，以提高这种重建技术的安全性。
