Trignano Emilio, Fallico Nefer, Fiorot Luca, Bolletta Alberto, Maffei Matteo, Ciudad Pedro, Maruccia Michele, Chen Hung-Chi, Campus Gian Vittorio
Department of Plastic and Reconstructive Surgery, University of Sassari, Sassari 07100, Italy.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung 40447, Taiwan, Republic of China.
Microsurgery. 2018 May;38(4):402-406. doi: 10.1002/micr.30256. Epub 2017 Nov 13.
The best method for the postoperative monitoring of flaps in reconstructive surgery is still a matter of debate. The aim of this study is to evaluate the usefulness of an oxygen partial tension monitoring system for the postoperative follow-up of a series of breast flaps, in addition to the traditional periodical clinical evaluations.
Twenty-one consecutive female patients (mean age: 61 years) who underwent free- or pedicled-flap reconstruction of the breast were included in the study. Fifteen patients had a deep inferior epigastric perforator flap breast reconstruction, while the remaining six patients underwent a transverse rectus abdominus myocutaneous flap reconstruction. The Licox Recon (Integra LifeSciences Corp, Plainsboro, New Jersey) system was used for the monitoring of the flaps. The oxygen partial tension (PtO ) values were displayed on the system monitor and registered with appropriate software for statistical analysis.
A decreasing trend in the mean PtO values was observed over the first five postoperative days. The mean values registered in the first postoperative day were higher than those observed in the subsequent four days. Three patients were lost due to misplacement of the probe. Among the remaining 18 flaps, 3 (17%) reported a remarkable decrease in PtO values, with the mean PtO registered in the second postoperative day being significantly lower than in the other flaps (7.3 ± 0.7 vs. 17.0 ± 0.9; P-value <.05). These three flaps have been promptly re-explored, with a final flap failure rate of 5.5% (1 flap).
The continuous oxygen tension evaluation represents a promising method for the postoperative monitoring of breast reconstructive surgery flaps when used in combination with the traditional periodic clinical evaluations.
在重建手术中，用于皮瓣术后监测的最佳方法仍存在争议。本研究的目的是，除了传统的定期临床评估外，评估氧分压监测系统在一系列乳房皮瓣术后随访中的作用。
本研究纳入了21例连续接受乳房游离皮瓣或带蒂皮瓣重建的女性患者（平均年龄：61岁）。15例患者接受了腹壁下深动脉穿支皮瓣乳房重建，其余6例患者接受了腹直肌肌皮瓣重建。使用Licox Recon（Integra LifeSciences Corp，新泽西州普林斯顿）系统监测皮瓣。氧分压（PtO）值显示在系统监视器上，并使用适当的软件进行记录以进行统计分析。
术后前五天观察到平均PtO值呈下降趋势。术后第一天记录的平均值高于随后四天观察到的值。3例患者因探头放置不当而失访。在其余18个皮瓣中，3个（17%）报告PtO值显著下降，术后第二天记录的平均PtO值明显低于其他皮瓣（7.3±0.7 vs. 17.0±0.9；P值<.05）。这三个皮瓣立即进行了再次探查，最终皮瓣失败率为5.5%（1个皮瓣）。
当与传统的定期临床评估相结合时，连续氧分压评估是一种用于乳房重建手术皮瓣术后监测的有前景的方法。
