Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect
Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect
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DOI：
10.1097/01.prs.0000481071.59025.82
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发表时间：
2016-04-01
影响因子：
3.6
通讯作者：
Lee, Bernard T.
中科院分区：
文献类型：
--
作者：
Koolen, Pieter G. L.;Vargas, Christina R.;Lee, Bernard T.
背景：早期的研究表明，近红外线监测与组织血氧饱和度显示了提供早期检测游离皮瓣血管受损的前景。然而，这种技术对皮瓣结果的大规模临床评价以前尚未建立。本研究调查了10年内组织血氧测定对皮瓣再探查率和挽救率的影响。这种新技术的学习曲线也assessed.Methods：前瞻性地保持在学术机构进行的所有显微乳房重建的数据，从2004年至2014年进行了回顾性审查。患者被分为两组标准临床监测组和标准临床监测加组织血氧测定组，比较再探查率和皮瓣挽救率。进行亚组分析（三分位数），以评估结果与不断增加的experience.Results：共380皮瓣（36.2%）接受标准的临床监测，和670皮瓣（63.8%）接受额外的组织血氧监测。实施组织血氧监测前的皮瓣保留率为57.7%，提高到96.6%（p < 0.001）。使用组织血氧测定法后，皮瓣完全丧失的数量从11例（2.9%）减少到1例（0.1%）（p < 0.001）。亚组分析表明，在第三个tertile.Conclusions：纳入连续组织血氧饱和度在显微乳房重建术后监测协议的再探索显着减少与挽救率显着提高，皮瓣损失。此外，学习曲线评估表明，随着时间的推移，使用组织血氧测定法可以降低再探查率。
Background:Early studies have shown that near-infrared monitoring with tissue oximetry shows promise in providing earlier detection of free flap vascular compromise. However, large-scale clinical evaluation of this technology on flap outcome has not previously been established. This study examines the effect of tissue oximetry on flap reexploration rates and salvage over a 10-year period. The learning curve for this new technology is also assessed.Methods:A retrospective review was performed of prospectively maintained data on all microsurgical breast reconstructions performed at an academic institution from 2004 to 2014. Patients were divided into two separate cohorts-standard clinical monitoring and standard clinical monitoring plus tissue oximetry-and rates of reexploration and flap salvage were compared. Subgroup analysis (tertiles) was performed to assess outcomes with increasing experience.Results:A total of 380 flaps (36.2 percent) received standard clinical monitoring, and 670 flaps (63.8 percent) received additional tissue oximetry monitoring. The rate of flap salvage before implementation of tissue oximetry monitoring was 57.7 percent and increased to 96.6 percent (p < 0.001). The number of complete flap losses decreased from 11 (2.9 percent) to one (0.1 percent) with the use of tissue oximetry (p < 0.001). Subgroup analysis demonstrated significantly fewer reexplorations in the third tertile.Conclusions:Inclusion of continuous tissue oximetry in the postoperative monitoring protocol of microsurgical breast reconstruction is associated with significantly improved salvage rates and fewer flap losses. Furthermore, learning curve assessment demonstrates that use of tissue oximetry can decrease the rate of reexploration over time.