Duygu Ece Kumbasar, MBBCh, is a plastic surgery fellow at Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.
Ahmed Hagiga, MBBCh, is a plastic surgery fellow at Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom.
Plast Surg Nurs. 2021;41(2):108-111. doi: 10.1097/PSN.0000000000000380.
Free flap reconstruction is a common procedure with success rates greater than 99%. However, vascular complications may occur, resulting in flap failure. For this reason, early detection of vascular compromise is crucial for flap salvage. Vascular complications may be detected early by monitoring tissue oximetry parameter changes using near-infrared spectroscopy (NIRS). This method of noninvasive monitoring can evaluate changes in flap oxygenation levels caused by arterial and venous thrombosis before surgical reexploration. The goal of this study was to assess the validity of using NIRS oximetry for monitoring free flaps. We conducted a prospective cohort observational study of 10 patients undergoing breast reconstruction. We used the INVOS 7100 cerebral oximetry monitoring system (Medtronic, Dublin, Ireland) to provide 24-hr continuous postoperative monitoring of flap perfusion and compared the data with clinical assessment findings. The median patient age was 57 years (range = 41-61 years). Patients underwent immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap surgery (n = 4), delayed reconstruction with DIEP flap surgery (n = 4), transverse upper gracilis flap surgery (n = 1), and latissimus dorsi flap with lipofilling (n = 1). We successfully monitored all 10 flaps for 24 hr postoperatively. The overall flap survival rate was 100%. Findings of clinical examination, Doppler studies, and surgical outcome were consistent with NIRS monitoring. In conclusion, NIRS tissue oximetry could potentially provide a noninvasive method for effective postoperative monitoring of free flaps.
游离皮瓣重建是一种成功率超过 99%的常见手术。然而，可能会发生血管并发症，导致皮瓣失败。因此，早期发现血管受损对于皮瓣挽救至关重要。通过近红外光谱 (NIRS) 监测组织血氧参数变化，可以早期发现血管并发症。这种非侵入性监测方法可以在手术再次探查之前评估动脉和静脉血栓形成引起的皮瓣氧合水平变化。本研究旨在评估使用 NIRS 血氧仪监测游离皮瓣的有效性。我们对 10 例行乳房重建的患者进行了前瞻性队列观察研究。我们使用 INVOS 7100 脑血氧监测系统（Medtronic，都柏林，爱尔兰）提供 24 小时连续术后皮瓣灌注监测，并将数据与临床评估结果进行比较。中位患者年龄为 57 岁（范围=41-61 岁）。患者接受了即时乳房重建术，包括深部下腹壁穿支皮瓣 (DIEP) 手术（n=4）、延迟重建术，包括 DIEP 皮瓣手术（n=4）、横行上股薄肌皮瓣手术（n=1）和带脂肪填充的背阔肌皮瓣（n=1）。我们成功地对所有 10 个皮瓣进行了 24 小时术后监测。总的皮瓣存活率为 100%。临床检查、多普勒研究和手术结果的发现与 NIRS 监测一致。总之，NIRS 组织血氧测定可能为游离皮瓣的有效术后监测提供一种非侵入性方法。
