Clinic for Plastic and Hand Surgery, Burn Care Center, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, 51109 Cologne, Germany.
Institute for Research in Operative Medicine (IFOM), Faculty of Health, University of Witten/Herdecke, 51109 Cologne, Germany.
Medicina (Kaunas). 2024 Aug 16;60(8):1327. doi: 10.3390/medicina60081327.
: Postoperative monitoring, following free flap surgery, plays a crucial role in ensuring the survival of the flap. However, in microsurgery, not only the immediate postoperative monitoring period but also the choice of the right time for secondary surgeries is crucial for the free flap survival. There is no clear consensus concerning the right choice of timing for secondary surgery. Our aim was to evaluate transepidermal water loss (TEWL), with the objective evaluation tool Tewameter in free flap surgery to monitor flap autonomization. : Transepidermal water loss was assessed in 20 patients with microsurgically transplanted free anterior lateral thigh (ALTP) flaps. The transplantation of the ALTP-flap and the postoperative care were administered in accordance with the standard of care of the department. Measures were taken on the free flap and normal skin at follow-ups of 1, 3, and 6 months after initial free flap transplantation. : Transepidermal water loss gradually increased to the values found in normal skin, after 6 months. The differences between the two areas demonstrated the smallest variance after 6 months, specifically in the ALTP-flap region. The largest disparities were observed between month 1 and month 6, followed by month 3 and month 6, and month 1 and month 3. : Free flap autonomization and physiology are complex processes. TEWL might be a valuable parameter to monitor flap autonomization. Our results indicate that TEWL in the free flap is nearly "normal" after six months. For a clear consensus of when to perform individual secondary surgery, further studies are needed.
术后监测在游离皮瓣手术后起着至关重要的作用，确保皮瓣的存活。然而，在显微外科中，不仅术后即刻监测期，而且选择进行二次手术的正确时间对于游离皮瓣的存活也至关重要。对于何时进行二次手术的最佳时机，尚无明确共识。我们的目的是使用客观评估工具 Tewameter 评估游离皮瓣手术中的经皮水分丢失（TEWL），以监测皮瓣自主化。
我们评估了 20 例接受游离前外侧大腿（ALTP）皮瓣显微移植的患者的经皮水分丢失情况。ALTP 皮瓣的移植和术后护理按照科室的标准护理进行。在游离皮瓣移植后的 1、3 和 6 个月进行随访，在游离皮瓣和正常皮肤处进行测量。
游离皮瓣的经皮水分丢失逐渐增加，直至 6 个月后达到正常皮肤的水平。在 6 个月后，两个区域之间的差异显示出最小的变化，特别是在 ALTP 皮瓣区域。1 个月和 6 个月之间的差异最大，其次是 3 个月和 6 个月之间，以及 1 个月和 3 个月之间。
游离皮瓣的自主化和生理学是复杂的过程。TEWL 可能是监测皮瓣自主化的一个有价值的参数。我们的结果表明，游离皮瓣的 TEWL 在 6 个月后几乎“正常”。为了达成何时进行个体化二次手术的明确共识，需要进一步研究。
