A Prospective Analysis of Free Flap Monitoring Techniques: Physical Examination, External Doppler, Implantable Doppler, and Tissue Oximetry
A Prospective Analysis of Free Flap Monitoring Techniques: Physical Examination, External Doppler, Implantable Doppler, and Tissue Oximetry
复制标题
DOI：
10.1055/s-0032-1326741
复制
发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Djohan, Risal
中科院分区：
文献类型：
--
作者：
Lohman, Robert F.;Langevin, Claude-Jean;Djohan, Risal
没有普遍接受的皮瓣监测方法存在，并使用了几种技术。重复体检是最常见的，通常辅以手持式、外置和/或植入式多普勒探头；近红外光谱不太常用。我们调查了护理人员和住院部工作人员对皮瓣监测体检的经验和信心。采用体格检查、体外多普勒、植入式动脉和静脉多普勒探针以及近红外光谱对连续38例游离皮瓣患者进行监测。5例患者在手术3天内出现微血管并发症的迹象；所有这些都被勘探和打捞出来。住院医师和护理人员都没有接受过普遍的体检皮瓣监测培训或经验。在所有患者中，在辅助监测方法提示问题发生后30至60分钟，皮瓣外观的变化提示微血管并发症。近红外光谱是5名患者中4名患者的第一个预警信号。2例患者在吻合口血栓形成前进行探查。近红外光谱比体格检查、体外多普勒或植入式多普勒更可靠地识别早期微血管并发症。
No universally accepted method of flap monitoring exists, and several techniques are in use. Repeated physical examination is most popular and is often supplemented with a handheld, external Doppler, and/or implantable Doppler probes; near-infrared spectroscopy is less commonly used. We investigated the nursing and resident house staff's experience and confidence with physical exam for flap monitoring. Also, a consecutive series of 38 patients with free flaps were monitored using physical examination, external Doppler, implantable arterial and venous Doppler probes, and near-infrared spectroscopy. Five patients developed signs of microvascular complications within 3 days of surgery; all were explored and salvaged. Neither the residents nor the nursing staff were universally trained or experienced in flap monitoring by physical exam. In all patients, changes in the appearance of the flap suggestive of a microvascular complication lagged 30 to 60 minutes after the adjunctive monitoring methods indicated that a problem had occurred. Near-infrared spectroscopy was the first warning sign in four of the five patients. Two patients were explored before thrombosis of the anastomoses occurred. Near-infrared spectroscopy may identify early microvascular complications more reliably than physical examination, external Doppler, or implantable Doppler.