Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy
Continuous postoperative monitoring of cutaneous free flaps using near infrared spectroscopy
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DOI：
10.1016/j.bjps.2007.04.003
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发表时间：
2008-01-01
影响因子：
2.7
通讯作者：
Arnez, Zoran M.
中科院分区：
文献类型：
--
作者：
Repez, Andrej;Oroszy, Dominika;Arnez, Zoran M.
可靠地检测威胁游离皮瓣存活的循环障碍对于及时的外科干预和皮瓣挽救是至关重要的。许多技术已被开发出来，以解决术后皮瓣监测的问题，但没有一个已获得普遍接受。近红外光谱（NIRS）是一种无创技术，可以连续监测组织氧合和灌注。它越来越被认为是一种可靠的方法来评估皮瓣的可行性。本研究旨在探讨近红外光谱检测和识别微血管血栓危及皮瓣存活的能力。据我们所知，这是第一个临床评价的近红外光谱用于连续监测游离flaps.Methods：50皮瓣用于自体乳房再造48例患者被纳入这项前瞻性临床研究。采用近红外光谱技术进行术后72 h连续监测。结果：10个皮瓣（20%）开发了13个吻合口血栓（2个动脉和11个静脉）。NIRS在临床观察之前检测到所有流动故障病例，无假阳性或假阴性。基于NIRS参数变化的一致模式，在手术再探查之前可以准确区分动脉和静脉血栓形成引起的变化。治愈率为70%。结论：连续NIBS监测能可靠地检测和识别早期动脉和静脉血栓形成，是一种可靠的无创性皮瓣术后监测方法。基于这些发现，我们主张使用它来监测皮瓣与皮肤的组成部分。(c)2007年由Elsevier Ltd代表英国整形、重建和美容外科医生协会出版。
Reliable detection of circulatory compromise threatening free-flap viability is essential for prompt surgical intervention and flap salvage. Numerous techniques have been developed to address the issue of postoperative flap monitoring but none have achieved universal acceptance. Near infrared spectroscopy (NIRS) is a noninvasive technique that allows continuous monitoring of tissue oxygenation and perfusion. It is increasingly recognised to be a reliable method for flap viability assessment. This study was designed to investigate the ability of NIRS to detect and identify microvascular thrombosis endangering flap survival. To our knowledge, this is the first clinical evaluation of NIRS used for continuous monitoring of free flaps.Methods: Fifty flaps used for autologous breast reconstruction in 48 patients were included in this prospective clinical study. NIRS was employed for 72-h continuous postoperative monitoring. The data were compared to findings of clinical assessments.Results: Ten flaps (20%) developed 13 anastomosis thromboses (two arterial and 11 venous). NIRS detected all cases of flow failure prior to clinical observation with no false positives or negatives. Based on consistent patterns of NIRS parameter changes, it was possible to differentiate between changes caused by arterial and venous thrombosis with accuracy before surgical re-exploration. The salvage rate was 70%. Overall flap viability was 94%.Conclusions: Continuous NIBS monitoring can reliably detect and identify early stages of arterial and venous thrombosis, and is a credible method for noninvasive postoperative flap surveillance. Based on these findings, we advocate its use for monitoring of flaps with a cutaneous component. (c) 2007 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.