Pafitanis Georgios, Raveendran Maria, Myers Simon, Ghanem Ali M
Academic Plastic Surgery, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
University of Toronto, United Kingdom.
J Plast Reconstr Aesthet Surg. 2017 Sep;70(9):1242-1251. doi: 10.1016/j.bjps.2017.05.010. Epub 2017 May 20.
This review aims to provide a summary of the flowmeter devices used in microvascular surgery and assesses their contribution to improving the clinical outcomes of free tissue transfer. Flowmeters are widely accepted as the standard method of intraoperative assessment of the patency of coronary vascular anastomoses, providing thresholds that predict outcome. There is limited evidence regarding the use of flow measurements in plastic surgery microvascular anastomoses; however, flowmetry appears to have some role in postoperative free flap monitoring and prevention of complications. Surgeons rely on subjective clinical robust findings (patency test) as proof of immediate flow. The current literature lacks evidence regarding an objective predictor tool used to evaluate adequate flow changes before and after microvascular anastomosis. An electronic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement by using the MEDLINE, EMBASE, and Cochrane databases. A combination of algorithms including "flowmeter," "Doppler ultrasound," "transit volume flow," and "laser Doppler flowmeter" meshed with "microsurgery" was used to search for experimental and clinical studies that assess microvascular anastomoses by using a flowmeter device. A total of 718 peer-reviewed publications and 14 full-text articles described the use of microvascular flowmeters to determine anastomotic patency or free flap viability. Flowmeters are currently used to provide the qualitative assessment of microvascular anastomoses. It seems reasonable to expect flowmetry to provide quantitative values that can be used intraoperatively to predict both outcomes and the necessity for an on-table anastomosis revision; this may allow surgeons to better understand the other factors that predict failure by exclusion.
本综述旨在总结微血管手术中使用的流量计设备，并评估它们对改善游离组织移植临床结果的贡献。流量计被广泛认为是术中评估冠状动脉血管吻合口通畅性的标准方法，提供预测结果的阈值。关于在整形手术微血管吻合中使用流量测量的证据有限；然而，流量测量似乎在术后游离皮瓣监测和并发症预防中具有一定作用。外科医生依靠主观的临床确凿发现（通畅性测试）作为即时血流的证据。目前的文献缺乏关于用于评估微血管吻合前后适当血流变化的客观预测工具的证据。根据系统评价和Meta分析的首选报告项目声明，通过使用MEDLINE、EMBASE和Cochrane数据库进行了电子文献检索。使用包括“流量计”、“多普勒超声”、“通过体积流量”和“激光多普勒流量计”与“显微外科”相结合的算法组合来搜索通过使用流量计设备评估微血管吻合的实验和临床研究。共有718篇同行评审出版物和14篇全文文章描述了使用微血管流量计来确定吻合口通畅性或游离皮瓣活力。目前流量计用于对微血管吻合进行定性评估。期望流量测量能够提供术中可用于预测结果和台上吻合口修订必要性的定量值似乎是合理的；这可能使外科医生能够通过排除更好地了解预测失败的其他因素。
