Kodama Hiroki, Ishida Katsuhiro, Hirayama Haruyuki, Orgun Doruk, Kawashima Kazuho, Nikkhah Dariush, May James, Kyriacou Panicos A, Miyawaki Takeshi
Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Research Centre for Biomedical Engineering, City, University of London, London, United Kingdom.
JPRAS Open. 2024 Nov 17;43:140-152. doi: 10.1016/j.jpra.2024.11.004. eCollection 2025 Mar.
This study evaluated the effectiveness of laser Doppler flowmetry (LDF) in detecting perfusion disturbances during microvascular free tissue transfer.
Conducted at a single centre from December 2020 to September 2022, this prospective study involved 71 patients mainly undergoing head and neck free flap reconstructions, using the Pocket LDF™ for continuous perfusion monitoring.
Out of the 71 cases, data from 69 cases were analysed after excluding those with significant noise or sensor detachment. Blood flow disturbances were observed in 9 cases (13.0 %), with 5 of these cases with a history of surgery or radiation in the same area. There were 5 cases of ischaemia, 4 of which occurred during monitoring. There were 4 cases of venous congestion, with 1 occurring during monitoring. Re-operation was necessary in 8 cases (11.6 %), involving flap replacements, vascular re-anastomoses and hematoma evacuation. Complete flap necrosis occurred in 5 cases (7.2 %) and partial necrosis occurred in 3 cases (4.3 %). The LDF device demonstrated the ability to identify perfusion issues hours before the clinical symptoms manifested, suggesting its potential for early intervention. However, challenges included maintaining continuous monitoring immediately post-surgery and during patient transfers.
LDF is a valuable, non-invasive tool for early detection of perfusion disturbances in free flap procedures. It provides continuous, real-time feedback on microcirculation, facilitating timely interventions. Despite its benefits, enhancements in sensor adhesion and wireless technology are needed to improve monitoring reliability. Further studies are recommended to refine LDF usage and validate its efficacy in various clinical settings.
本研究评估激光多普勒血流仪（LDF）在检测游离组织微血管移植过程中灌注障碍方面的有效性。
本前瞻性研究于2020年12月至2022年9月在单一中心进行，纳入71例主要接受头颈部游离皮瓣重建的患者，使用Pocket LDF™进行连续灌注监测。
71例患者中，排除有明显噪音或传感器脱落的病例后，对69例患者的数据进行了分析。观察到9例（13.0%）存在血流障碍，其中5例在同一区域有手术或放疗史。有5例缺血，其中4例在监测期间发生。有4例静脉淤血，其中1例在监测期间发生。8例（11.6%）需要再次手术，包括皮瓣置换、血管重新吻合和血肿清除。5例（7.2%）发生皮瓣完全坏死，3例（4.3%）发生部分坏死。LDF设备显示出在临床症状出现前数小时识别灌注问题的能力，表明其具有早期干预的潜力。然而，挑战包括术后立即和患者转运期间维持连续监测。
LDF是一种有价值的非侵入性工具，可早期检测游离皮瓣手术中的灌注障碍。它提供关于微循环的连续、实时反馈，便于及时干预。尽管有其优点，但仍需要改进传感器附着力和无线技术以提高监测可靠性。建议进一步研究以完善LDF的使用并验证其在各种临床环境中的疗效。
