在1367例连续的乳房游离皮瓣手术中比较组织血氧饱和度测定法与多普勒监测法。

Comparing tissue oximetry to doppler monitoring in 1367 consecutive breast free flaps.

作者信息

Johnson Braden M, Cullom Melissa E, Egan Katie G, Nazir Niaman, Elver Ashlie A, Limpiado MarcArthur J, Lai Eric C, Butterworth James A

机构信息

Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.

Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA.

出版信息

Microsurgery. 2023 Jan;43(1):57-62. doi: 10.1002/micr.30873. Epub 2022 Mar 3.

DOI:10.1002/micr.30873

PMID:35238069

Abstract

BACKGROUND

Retrospective studies evaluating tissue oximetry in a more recent cohort have shown superiority in flap outcomes. This study compares the use of tissue oximetry in a historical cohort to clinical observation and handheld doppler in a more recent cohort. We hypothesize that there is no benefit to using tissue oximetry.

METHODS

A retrospective review was performed on patients who underwent abdominal-based autologous breast reconstruction by five microsurgeons at an academic institution from 2009 to 2020. Method of postoperative flap monitoring was determined then operative details and complications were analyzed.

RESULTS

1367 flaps were reviewed; 740 flaps in 460 patients were monitored with clinical observation and tissue oximetry, and 627 flaps in 391 patients were monitored with clinical observation and handheld doppler. There were no statistical differences in ischemic (p = .59) or congestive complications (p = .41), flap salvage rates when exploring for venous or arterial compromise (p = .52), or early flap loss (p = .56). Although not significant, acute flap-related return to the operating room was lower in the doppler group (4.6%) compared to the oximetry group (6.1%; p = .22). Flaps monitored with tissue oximetry had a statistical increase in length of stay (4.8 ± 1.4 days vs. 3.8 ± 1.6 days; p ≤ .001). The rates of late partial flap loss and fat necrosis were significantly higher in the oximetry group (2.6%, 19/740 vs. 0.3%, 2/740; p = .04) and (18.2%, 135/740 vs. 13.6%, 85/627; p = .02), respectively.

CONCLUSIONS

There is no statistical benefit to the use of tissue oximetry compared to handheld doppler in flap monitoring with regards to flap outcomes.

摘要

背景

评估近期队列中组织血氧饱和度的回顾性研究显示，在皮瓣预后方面具有优势。本研究将历史队列中组织血氧饱和度的使用情况与近期队列中的临床观察和手持多普勒进行比较。我们假设使用组织血氧饱和度没有益处。

方法

对2009年至2020年在一所学术机构由五位显微外科医生进行腹部自体乳房重建的患者进行回顾性研究。确定术后皮瓣监测方法，然后分析手术细节和并发症。

结果

共回顾了1367例皮瓣；460例患者的740例皮瓣采用临床观察和组织血氧饱和度监测，391例患者的627例皮瓣采用临床观察和手持多普勒监测。在缺血性并发症（p = 0.59）或充血性并发症（p = 0.41）、探查静脉或动脉受损时的皮瓣挽救率（p = 0.52）或早期皮瓣丢失（p = 0.56）方面，两组无统计学差异。虽然差异不显著，但多普勒组急性皮瓣相关返回手术室的比例（4.6%）低于血氧饱和度监测组（6.1%；p = 0.22）。采用组织血氧饱和度监测的皮瓣住院时间有统计学意义的增加（4.8±1.4天 vs. 3.8±1.6天；p≤0.001）。血氧饱和度监测组晚期部分皮瓣丢失率和脂肪坏死率显著更高（分别为2.6%，19/740 vs. 0.3%，2/740；p = 0.04）和（18.2%，135/740 vs. 13.6%，85/627；p = 0.02）。