Techniques of Monitoring Buried Fasciocutaneous Free Flaps
Techniques of Monitoring Buried Fasciocutaneous Free Flaps
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DOI：
10.1097/prs.0b013e318196b9a3
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发表时间：
2009-02-01
影响因子：
3.6
通讯作者：
Yu, Peirong
中科院分区：
文献类型：
--
作者：
Ferguson, Robert E. H., Jr.;Yu, Peirong
背景资料：虽然术后监测显微外科重建的关键是发现早期血管妥协，监测埋皮瓣可以problem.Methods：一个单一的外科医生的气管和咽食管重建筋膜皮瓣之间进行审查，2002年和2007年，不同的监测技术进行了描述。其中股前外侧皮瓣78例，前臂桡侧皮瓣16例。使用了三种不同的监测技术。在第一组中，一个组成部分的皮瓣用于颈部表面重建同时作为一个监测段在59例患者。无皮瓣受损或失效发生。在第二组中，无论是植入式或手持多普勒设备被用来监测一个完全掩埋的皮瓣在29名患者。植入式多普勒的假阳性率为31%，导致不必要的手术探查。植入式和手持式多普勒方法各发生1例未识别的皮瓣丢失。在第三组中，一段组织分离的主皮瓣，但共享相同的源血管暂时外化监测和患者出院前在6名患者中删除。这种技术也被用于一个病人的前外侧股皮瓣颞重建。有没有血栓形成或皮瓣损失在这些patients.Conclusions：暂时externalizing一段组织是一种简单可靠的方法，用于监测埋筋膜皮瓣。然而，重要的是要避免在共同来源血管以外的穿支水平阻塞。（Plast。重建123：525，2009）。
Background: Although postoperative monitoring of microsurgical reconstruction is key to discovering early vascular compromise, monitoring a buried flap can be problematic.Methods: A single surgeon's tracheal and pharyngoesophageal reconstructions with fasciocutaneous free flaps performed between 2002 and 2007 are reviewed, and different monitoring techniques are described.Results: Eighty-six cases of pharyngoesophageal and eight tracheal reconstructions were identified. The anterolateral thigh flap was used in 78 patients and the radial forearm flap was used in 16 patients. Three different monitoring techniques were used. In group I, a component of the flap used for neck resurfacing simultaneously served as a monitoring segment in 59 patients. No flap compromise or failure occurred. In group II, either an implantable or handheld Doppler device was used to monitor a completely buried flap in 29 patients. The implantable Doppler had a false-positive rate of 31 percent, leading to unnecessary surgical exploration. One case each of unrecognized flap loss occurred with the implantable and handheld Doppler methods. In group III, a segment of tissue separate from the main flap but sharing the same source vessels was temporarily externalized for monitoring and removed before patient discharge in six patients. This technique was also used in a patient with an anterolateral thigh flap for temporal reconstruction. There was no thrombosis or flap loss in these patients.Conclusions: Temporarily externalizing a segment of tissue is an easy and reliable method for monitoring a buried fasciocutaneous free flap. It is important, however, to avoid obstruction at the perforator level beyond the common source vessels. (Plast. Reconstr. Surg. 123: 525, 2009.)