[Newly designed skin temperature monitoring system for microvascular anastomosis--an experimental and clinical study (author's transl)].

Blood circulation must be carefully evaluated following the microvascular anastomosis, such replantation of the digits and hands, free toe-to-hand transfer, and free flaps. From May 173, we have performed replantation of forty-five digits, seven wrists or forearm in thirty-four patients and one leg in one patient. The overall survival rate was 92.5%, including near total amputation. Also, from May 1974, we have performed eleven free flaps or free musculocutaneous flaps in ten patients. Seven out of eleven free flaps survived without any problems. The clinical inspections such as skin color and capillary refill are of subjective nature, and not always reliable. Therefore, from 1974, we have been measuring the skin temperature in the revascularized parts by means of a thermister. We usually use an electric blanket to warm the proximal part of the operated limb to maintain the peripheral circulation. Under normal ward environment, we analyzed the patterns of temperature fluctuations, and compared them against the revascularized parts and control sites. On our animal experiments, with the rats' hind limbs, a drastic temperature drop by about 2.0 degrees C was observed in 30 min, compared against the control group, when either artery or vein or both were obstructed. In the cases of the replantations, the skin temperature of control digits ranged from 30.4 to 37.1 degrees C. It usually remained above 32.0 degrees, fluctuating within 3 degrees. Also the skin temperatures of the successfully replanted parts and free flaps usually indicated the level above 32.0 degrees C, which corresponds to more than 80% of the axillary temperature in replanted cases and 90% in free flaps. In one failure case of replantation, the skin temperature fluctuated fom 27.2 to 32.1 degrees. On the fifth post operative day, the temperature suddenly dropped by 5 degrees in two hours. Arteriography was performed, and the arterial obstruction was confirmed. For the four flap operations, the skin temperatures had dropped below 32.0 degrees C, of which two had recovered by an auto-vein graft and the removal of haematoma respectively. We have concluded from these results, that the critical skin temperature in replantation and free flap cases was apparently above 32.0 degrees C in the normal ward environment. Based on our experiences, we have designed a continuous skin temperature monitoring device which consists of a resistance bridge and a thermister. The power source is a D.C. 12V. A high accuracy is maintained at the range of 32.1 +/- 0.3 degrees C when the system is set at 32.0 degrees C in the ward. The circuit is designed to flash a blue lamp when the temperature of the operated site is maintained above the pre-established temperature, while a red lamp and buzz signal give a warning when the temperature drops below the pre-established temperature. This equipment and skin thermometer have been simultaneously used following the various operations of microvascular anastomoses...