Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Decreases Flap Loss and Improves Rate of Flap Salvage
Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Decreases Flap Loss and Improves Rate of Flap Salvage
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DOI：
10.1097/prs.0b013e31820436cb
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发表时间：
2011-03-01
影响因子：
3.6
通讯作者：
Lee, Bernard T.
中科院分区：
文献类型：
--
作者：
Lin, Samuel J.;Nguyen, Minh-Doan;Lee, Bernard T.
背景：自微血管游离组织移植以来，皮瓣监测一直以临床体征为基础。术后使用彩色、毛细血管充盈和手持多普勒进行监测；然而，主观的临床检查可能会延迟对皮瓣损伤的识别。组织血氧仪监测提供了一种客观的方法，通过测量组织氧饱和度和实时组织瓣灌流来检测血管受损情况。方法：作者回顾了2004-2010年间连续614例显微外科乳房再造手术。作者对首批380例患者进行了临床皮瓣术后监测。从2008年6月开始，作者对234名连续的患者使用了组织血氧仪作为辅助手段。结果：使用组织血氧测定仪前，有26例(6.8%)再次探查，11例(2.9%)皮瓣丢失。组织氧饱和度测定后，16例(6.8%)皮瓣再次探查，1例皮瓣丢失。两组间皮瓣再探查率差异无统计学意义，但皮瓣失败率差异有统计学意义(p=0.025)。组织血氧饱和度监测后为93.75%(P=0.015)。结论：在显微乳房重建术中，应用组织血氧饱和度测量技术，降低了患者的皮瓣损失率，提高了皮瓣的保存率。在术后监测中，该装置是一个有用的辅助设备，因为它可以在临床表现明显之前检测到即将发生的血管损害，从而帮助减少皮瓣的丢失。(最后一次。重新构造外科127：1080,2011年。)
Background: Since the inception of microvascular free tissue transfer, flap monitoring has been based on clinical signs. Color, capillary refill, and handheld Doppler have been used for monitoring in the postoperative period; however, subjective clinical examination may delay recognition of flap compromise. Tissue oximeter monitoring offers an objective method for detecting vascular compromise with the measurement of tissue oxygen saturation and real-time flap perfusion.Methods: The authors reviewed 614 consecutive microsurgical flaps for breast reconstruction from 2004 to 2010. The authors' first 380 patients underwent clinical flap postoperative monitoring. Starting in June of 2008, the authors used tissue oximetry as an adjunct on 234 consecutive patients. Flap reexploration, flap loss, salvage rate, fat necrosis, and characteristics of vascular compromise were analyzed.Results: There were 26 instances of flap reexploration (6.8 percent) and 11 flap losses (2.9 percent) before use of tissue oximetry. After tissue oximetry was used, there were 16 instances of flap reexploration (6.8 percent) and one flap loss. The rate of flap reexploration was not statistically significant between groups, but the difference between the flap failure rates is significant (p = 0.025). The flap salvage rate was previously 57.7 percent; after tissue oximetry monitoring, the flap salvage rate was 93.75 percent (p = 0.015).Conclusions: The use of tissue oximetry has decreased the authors' flap loss rate and improved the flap salvage rate in microsurgical breast reconstruction. This device is a useful adjunct in flap monitoring during the postoperative period, as it may help decrease flap loss by detecting impending vascular compromise before it becomes clinically evident. (Plast. Reconstr. Surg. 127: 1080, 2011.)