Microdialysis in postoperative monitoring of microvascular free flaps: Experiences with a decision algorithm.
J Craniomaxillofac Surg
; 47(8): 1306-1309, 2019 Aug.
Article
en En
| MEDLINE
| ID: mdl-31337567
ABSTRACT
BACKGROUND:
Reconstruction with free flaps has become a usual practice in maxillofacial surgery. Clinical monitoring is still the standard approach for postoperative follow-up, but can be difficult or impossible with intraorally situated or buried flaps. Microdialysis is a sampling technique that offers the possibility to monitor the metabolism of flaps continuously. It is a reliable method for early diagnosis of ischemia. MATERIALS ANDMETHODS:
48 microvascular free flaps applied following oral cancer resection were monitored with a microdialysis (MD) catheter, placed in the flap. Glucose, lactate, and lactate/pyruvate ratio were monitored using a bedside analyser for 5 days. 48 free flaps served as controls and were assessed (refill, flap temperature, and color) by clinical monitoring (CM).RESULTS:
12 flaps monitored by MD showed abnormal metabolism and underwent revision. Eight flaps were saved and four were lost within the first 5 days postoperatively. In addition, two flaps were lost at days 15 and 30 postoperatively, without previous complications. Four flaps assessed by CM developed complications, underwent revision, and were saved. In addition, five flaps were lost between the 8th and 23rd days postoperatively, without revision, due to missing previous clinical signs.CONCLUSION:
Postoperative monitoring of free flaps using a microdialysis decision algorithm allows early diagnosis of anastomotic complications. It is a clinically feasible and sensitive monitoring method for microvascular flaps, allowing surgical revision to be undertaken before clinical alteration takes place.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Procedimientos de Cirugía Plástica
/
Colgajos Tisulares Libres
Tipo de estudio:
Prognostic_studies
/
Screening_studies
Límite:
Humans
Idioma:
En
Revista:
J Craniomaxillofac Surg
Asunto de la revista:
ODONTOLOGIA
Año:
2019
Tipo del documento:
Article