Microdialysis in postoperative monitoring of microvascular free flaps: Experiences with a decision algorithm
| Autor: | Hendrik Naujokat, Björn Möller, Falk Birkenfeld, Jörg Wiltfang, Ann-Kristin Helmers, Nicolai Purcz |
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| Rok vydání: | 2018 |
| Předmět: |
Microdialysis
Ischemia Free flap Anastomosis Free Tissue Flaps 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Humans Monitoring methods Postoperative monitoring Monitoring Physiologic business.industry Background reconstruction 030206 dentistry Plastic Surgery Procedures medicine.disease eye diseases Catheter Otorhinolaryngology 030220 oncology & carcinogenesis Surgery Oral Surgery business Algorithm Algorithms |
| Zdroj: | Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 47(8) |
| ISSN: | 1878-4119 |
| Popis: | Background Reconstruction with free flaps has become a usual practice in maxillofacial surgery. Clinical monitoring is still the standard approach for postoperative follow-up, but can be difficult or impossible with intraorally situated or buried flaps. Microdialysis is a sampling technique that offers the possibility to monitor the metabolism of flaps continuously. It is a reliable method for early diagnosis of ischemia. Materials and methods 48 microvascular free flaps applied following oral cancer resection were monitored with a microdialysis (MD) catheter, placed in the flap. Glucose, lactate, and lactate/pyruvate ratio were monitored using a bedside analyser for 5 days. 48 free flaps served as controls and were assessed (refill, flap temperature, and color) by clinical monitoring (CM). Results 12 flaps monitored by MD showed abnormal metabolism and underwent revision. Eight flaps were saved and four were lost within the first 5 days postoperatively. In addition, two flaps were lost at days 15 and 30 postoperatively, without previous complications. Four flaps assessed by CM developed complications, underwent revision, and were saved. In addition, five flaps were lost between the 8th and 23rd days postoperatively, without revision, due to missing previous clinical signs. Conclusion Postoperative monitoring of free flaps using a microdialysis decision algorithm allows early diagnosis of anastomotic complications. It is a clinically feasible and sensitive monitoring method for microvascular flaps, allowing surgical revision to be undertaken before clinical alteration takes place. |
| Databáze: | OpenAIRE |
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