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OBJECTIVE: Investigate current practice patterns of head and neck microvascular reconstructive surgeons when removing an implantable Doppler after free flap surgery. STUDY DESIGN: Cross-sectional survey study. METHODS: Survey distributed to head and neck microvascular reconstructive surgeons. Data regarding years performing free tissue transfer, case numbers, management of implantable Doppler wire, and complications were collected. RESULTS: Eighty-five responses were analyzed (38,000 cases). Sixty-six responders (77.6%) use an implantable Doppler for postoperative monitoring, with 97% using the Cook-Swartz Doppler Flow Monitoring System. Among this group, 65.2% pull the wire after monitoring was complete, 3% cut the wire, and 31.8% have both cut and pulled the wire. Of those who have cut and pulled the wire, 48% report cutting and pulling the wire with equal frequency, 43% formerly pulled the wire and now cut the wire, and 9% previously cut the wire but now pull the wire. Of those who pull the wire, there were two injuries to the pedicle requiring return to the operating for flap salvage, and one acute venous congestion. Of the nine who previously pulled the wire, six (67%) cited concerns with major bleeding/flap compromise as the reason for cutting the wire. CONCLUSION: In this study, most surgeons use an implantable Doppler for monitoring of free flaps postoperatively. In extremely rare instances, pulling the implantable Doppler wire has resulted in flap compromise necessitating revision of the vascular anastomosis. Cutting the wire and leaving the proximal portion in the surgical site has been adopted as a management option. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:554-559, 2022.
Assuntos
Remoção de Dispositivo/estatística & dados numéricos , Retalhos de Tecido Biológico/irrigação sanguínea , Fluxometria por Laser-Doppler/métodos , Microcirculação , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Transversais , Remoção de Dispositivo/métodos , Retalhos de Tecido Biológico/cirurgia , Humanos , Fluxometria por Laser-Doppler/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Cuidados Pós-Operatórios/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Inquéritos e Questionários , Grau de Desobstrução VascularRESUMO
PURPOSE: Laser speckle flowgraphy (LSFG) is a noninvasive method for quantitative evaluation of blood flow using the mean blur rate (MBR) as the blood flow index. We investigated whether LSFG can intraoperatively detect the demarcation line after vessel dissection and reduce the incidence of anastomotic leakage (AL). METHODS: This study included 36 patients who underwent left-sided colorectal surgery. First, we compared the demarcation line (determined by LSFG) with the transection line (TL) at which the marginal vessels were divided. We then measured the MBR on both sides of the TL to determine where the MBR changed significantly. We investigated the presence or absence of significant differences between the MBR on the proximal side and that on the distal side of the TL. Finally, we retrospectively compared the patient characteristics and AL rates in the LSFG group (n = 36) and control group (n = 87). RESULTS: In total, 58.3% (21/36) of the demarcation lines determined by LSFG matched the TL. The median distance between the demarcation line determined by LSFG and the TL was 0.0 mm (0.0-12.1 mm). The MBR sharply decreased at the TL in 80.6% (29/36) of cases. The median MBR was significantly lower on the distal than proximal side. The AL rate was not significantly lower in the LSFG group than in the control group. CONCLUSION: LSFG accurately detected the demarcation line during surgery. However, LSFG did not reduce the incidence of AL.
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Colo/irrigação sanguínea , Colo/cirurgia , Fluxometria por Laser-Doppler/métodos , Índice de Perfusão , Reto/irrigação sanguínea , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/prevenção & controle , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Cuidados Intraoperatórios , Fluxometria por Laser-Doppler/instrumentação , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos RetrospectivosRESUMO
Background: We tested whether the level of endothelial dysfunction assessed by digital tonometry, and expressed as reactive hyperemia index (RHI), is related to occurrences of a discrepancy between fractional flow reserve (FFR) and the instantaneous wave free ratio (iFR) (ClinicalTrials.gov identifier: NCT03033810).Methods: We examined patients with coronary stenosis in the range of 40-70%, assessed by both FFR and iFR (system Philips-Volcano) for stable angina. We included consecutive patients with FFR and iFR in one native coronary artery, and who had had no previous intervention.Results: We included 138 patients. Out of those, 24 patients (17.4%) had a negative FFR (with an FFR value >0.8) and positive iFR (with a iFR value ≤0.89) - designated the FFRn/iFRp discrepancy group, and 22 patients (15.9%) had a positive FFR (≤0.8) and negative iFR (>0.89) - designated the FFRp/iFRn discrepancy. RHI was higher in the discrepancy groups compared the group without discrepancy (1.73 ± 0.79 vs. 1.48 ± 0.50, p = 0.025). However, this finding was not confirmed in multivariant logistic regression analyses. Patients with any type of discrepancy differed from the agreement group by having a higher occurrence of diabetes mellitus [9 patients (21.4%) vs. 36 patients (39.6%), p = 0.029], active smoking (23 patients or 54.8% vs. 26 patients or 28.6%, p = 0.003) and lower use of calcium channel blockers (9 patients, 21.4%, vs. 43 patients, 46.7%, p = 0.004).Conclusion: The presence of endothelial dysfunction can be associated with a discrepancy in FFR/iFR. However, RHI correlated with risk factors of atherosclerosis, not with FFR or iFR.
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Estenose Coronária , Endotélio Vascular/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Fluxometria por Laser-Doppler , Microcirculação/fisiologia , Design de Software , Idoso , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Fluxometria por Laser-Doppler/instrumentação , Fluxometria por Laser-Doppler/métodos , Masculino , Manometria/instrumentação , Manometria/métodos , Imagem de Perfusão do Miocárdio/métodos , Software , Resistência VascularRESUMO
The Cook-Swartz-Doppler probe is an easy to handle and reliable tool for free flap monitoring. In the head and neck region different confounders can affect the read out. We therefore analyzed the use of the Doppler probe regarding these potential difficulties and to compare the diagnostic accuracy in arterial or venous monitoring of free flaps in the head and neck region. A retrospective study was performed in which all patients were included who underwent free flap surgery in the head and neck region in the Department of Plastic Surgery and the Department of Maxillofacial Surgery of our institution between 2010 and 2018 and were monitored with an implanted Doppler probe. 147 free tissue transfers were included. No significance was found for arterial and venous placement of the Doppler probe for sensitivity (artery 83.3%; vein 84.6%; p = 0.87), specificity (artery 89.2%; vein 96.1%; p = 0.17) and negative predictive value (artery 96.7%; vein 94.2%; p = 0.55). A better positive predictive value for placing the Doppler probe around the artery (82.7%) than the vein (61.1%) was found in our study (p = 0.056). The better positive predictive value in arterial monitoring suggests that this is the more reliable measuring method to assess flap perfusion in the head and neck region.
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Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Monitorização Ambulatorial/métodos , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/fisiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Fluxometria por Laser-Doppler/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos RetrospectivosRESUMO
Introducción: La flujometría doppler constituye un método de control y evaluación para determinar la culminación de la gestación, permite entender de una mejor manera la dinámica fetoplacetaria lo que posibilita evitar todo riesgo que pueda dañar la maduración fetal, y a su vez la prematuridad, bajo peso al nacer y patologías de la preeclampsia. Objetivo: Determinar la utilidad de la flujometría doppler color, en el diagnóstico y manejo de la restricción de crecimiento intrauterino en embarazadas preeclámpticas. Métodos: Se realizó un estudio no experimental, transversal, de tipo descriptivo comparativo en el departamento de ecografía de la clínica Bolívar, Babahoyo - Ecuador durante el año 2013. Participaron 96 mujeres gestantes en edades entre 15 a 40 años, a las que se le realizó las intervenciones: Flujometría doppler, prueba de índice cerebro placentario, arteria cerebral media/arteria umbilical; para el análisis se emplearon los indicadores descriptivos entre las variables. Resultados: La prueba de índice cerebro placentario fue descompensada en el 53,1 por ciento de las mujeres, el volumen de líquido amniótico estuvo disminuido en el 46,9 por ciento, y la edad gestacional más vulnerable fue de las 32 a las 37 semanas de gestación. Conclusiones: La flujometría doppler con la prueba índice cerebro placentario es un indicador efectivo y seguro de bienestar fetal cuando esta prueba es normal, y un predictor de resultado adverso, así como un marcador de hipoxia fetal cuando está alterado, convirtiéndose en una herramienta útil para la decisión de interrumpir la gestación cuando la salud del feto está en peligro, o de mantener el embarazo cuando su comportamiento es normal(AU)
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Humanos , Feminino , Gravidez , Fluxometria por Laser-Doppler/instrumentação , Pré-Eclâmpsia/diagnóstico , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Puncturing blood vessels during percutaneous intervention in minimally invasive brain surgery can be a life threatening complication. Embedding a forward looking sensor in a rigid needle has been proposed to tackle this problem but, when using a rigid needle, the procedure needs to be interrupted and the needle extracted if a vessel is detected. As an alternative, we propose a novel optical method to detect a vessel in front of a steerable needle. The needle itself is based on a biomimetic, multi-segment design featuring four hollow working channels. Initially, a laser Doppler flowmetry probe is characterized in a tissue phantom with optical properties mimicking those of human gray matter. Experiments are performed to show that the probe has a 2.1 mm penetration depth and a 1 mm off-axis detection range for a blood vessel phantom with 5 mm s-1 flow velocity. This outcome demonstrates that the probe fulfills the minimum requirements for it to be used in conjunction with our needle. A pair of Doppler probes is then embedded in two of the four working channels of the needle and vessel reconstruction is performed using successive measurements to determine the depth and the off-axis position of the vessel from each laser Doppler probe. The off-axis position from each Doppler probe is then used to generate a 'detection circle' per probe, and vessel orientation is predicted using tangent lines between the two. The vessel reconstruction has a depth root mean square error (RMSE) of 0.3 mm and an RMSE of 15° in the angular prediction, showing real promise for a future clinical application of this detection system.
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Vasos Sanguíneos/diagnóstico por imagem , Fluxometria por Laser-Doppler/instrumentação , Fluxometria por Laser-Doppler/métodos , Agulhas , Algoritmos , Animais , Materiais Biomiméticos , Velocidade do Fluxo Sanguíneo , Encéfalo/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Oviposição , Imagens de Fantasmas , Vespas/anatomia & histologiaRESUMO
OBJECTIVES: Secondary aorto-oesophageal fistula is a rare, lethal complication occurring after thoracic endovascular aneurysmal repair. The cause of secondary aorto-oesophageal fistula is unknown, but a reduction in local oesophageal mucosal blood flow (OMBF) may be a basis for such a devastating sequela. Our study aims to develop a novel blood flow sensor probe to detect changes in OMBF after thoracic stent graft implantation in an experimental swine model. METHODS: A novel laser Doppler flowmetry sensor probe incorporating an optical fibre sensor within a nasogastric tube was developed using microelectromechanical system technology. OMBF was measured at various levels using this sensor probe, to test its feasibility before and after thoracic endovascular stent graft implantation covering Th4-Th8 vertebral levels in 6 swine. RESULTS: In the middle oesophagus (Th5-Th7), where the aorta was covered with a stent graft, the measured OMBFs were significantly decreased after thoracic endovascular stent graft implantation than those of baseline (8.6 ± 2.7 vs 18.4 ± 7.9 ml/min/100 g, P < 0.0001), followed by a plateau period for at least 2 h after stent grafting (8.7 ± 3.3 ml/min/100 g, P < 0.0001 vs baseline). OMBFs in the upper (Th1-Th3) and lower (Th9-Th11) oesophagus, where the aorta was not covered with a stent graft, were unaffected by thoracic endovascular stent grafting. CONCLUSIONS: The novel laser Doppler flowmetry sensor probe was useful to monitor precise changes of OMBF in a swine model, demonstrating a significant reduction in OMBF after thoracic endovascular stent graft implantation.
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Implante de Prótese Vascular , Procedimentos Endovasculares , Mucosa Esofágica/irrigação sanguínea , Fluxometria por Laser-Doppler/instrumentação , Stents , Procedimentos Cirúrgicos Torácicos , Animais , Aorta Torácica/cirurgia , Doenças da Aorta/etiologia , Fístula Esofágica/etiologia , Hemodinâmica , Masculino , Modelos Animais , Complicações Pós-Operatórias/etiologia , Fluxo Sanguíneo Regional , SuínosRESUMO
INTRODUCTION: Currently there is no consensus on what is the optimal method for monitoring free flaps. Our meta-analysis compared the free flap success and salvage rates of Cook-Swartz Implantable Doppler monitoring with clinical monitoring to gain insight into the relative benefit of these systems. METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 16, 2016. Search terms included free flap surgery, free flap microsurgery and implantable Doppler. Studies were included if they involved the comparison of Cook-Swartz Doppler and clinical assessment for monitoring free flap function. Studies using free flap monitoring as an outcome measure for drug treatment were also excluded. Sensitivity analysis using the leave-one-out approach was used to assay the reliability of the findings. RESULTS: Initial search identified 14 studies, of which five studies were included in the meta-analysis. Cook-Swartz Doppler had significantly better rate of free flap success and salvage than clinical monitoring methods (P values ≤ 0.006). Data did not markedly changed when each study was removed in turn, showing reliability of the findings. DISCUSSION: The Cook-Swartz Doppler as a monitoring method may result in a higher rate of free flap success and salvaging but also a greater frequency of false positives than conventional methods. Our analysis is limited by designs of included studies and by heterogeneity of clinical monitoring techniques. CONCLUSIONS: More studies are needed to evaluate if Cook-Swartz Doppler can be used alone, or to be better used as an adjunctive technique to complement the clinical method of monitoring.
Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Fluxometria por Laser-Doppler , Monitorização Ambulatorial/métodos , Cuidados Pós-Operatórios/métodos , Humanos , Fluxometria por Laser-Doppler/instrumentação , Microcirurgia/métodos , Próteses e Implantes , Reprodutibilidade dos Testes , Terapia de SalvaçãoRESUMO
The aim of this study was to adapt and evaluate laser Doppler perfusion monitoring (LDPM) together with custom-designed brain probes and software for continuous recording of cerebral microcirculation in patients undergoing neurosurgery. The LDPM system was used to record perfusion and backscattered light (TLI). These parameters were displayed together with the extracted heart rate (HR), pulsatility index (PI) and signal trends from adjustable time intervals. Technical evaluation was done on skin during thermal provocation. Clinical measurements were performed on ten patients undergoing brain tumour surgery. Data from 76 tissue sites were captured with a length varying between 10 s to 15 min. Statistical comparisons were done using Mann-Whitney tests. Grey and tumour tissue could be separated from white matter using the TLI signal (p < 0.05). The perfusion was significantly higher in grey and tumour tissue compared to white matter (p < 0.005). LDPM was successfully used as an intraoperative tool for monitoring local blood flow and additional parameters linked to cerebral microcirculation (perfusion, TLI, HR and PI) during tumour resection. The systems stability opens up for studies in the postoperative care of patients with, for example, traumatic brain injury or subarachnoid haemorrhage.
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Circulação Cerebrovascular , Fluxometria por Laser-Doppler/instrumentação , Procedimentos Neurocirúrgicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SoftwareRESUMO
A dual wavelength photoplethysmography (PPG) and laser Doppler flowmetry (LDF) sensor was developed to investigate the suitability of these techniques for monitoring bowel viability intraoperatively. Clinical measurements were obtained from thirty patients undergoing bowel surgery. Three measurements were performed at different stages of the operation. The amplitude of infrared PPG decreased from the baseline measurement to the pre-anastomosis measurement by 36% and LDF flux decreased by 21% for the same measurements. An increase of 33% in amplitude for infrared PPG was observed from the pre-anastomotic to post-anastomosis measurement; the equivalent increase was not seen for LDF flux. The results revealed that the sensor could potentially indicate changes in perfusion and blood flow at critical phases of surgery, thereby assisting in the early detection of inadequate blood supply in bowel tissue. The results also suggest that laser Doppler is more sensitive to movement artefact compared to PPG.
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Intestinos/cirurgia , Fluxometria por Laser-Doppler/métodos , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Fotopletismografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Desenho de Equipamento , Humanos , Intestinos/irrigação sanguínea , Fluxometria por Laser-Doppler/instrumentação , Pessoa de Meia-Idade , Fotopletismografia/instrumentação , Estudos ProspectivosRESUMO
Microvascular blood flow contrast is an important hemodynamic and metabolic parameter with potential to enhance in vivo breast cancer detection and therapy monitoring. Here we report on non-invasive line-scan measurements of malignant breast tumors with a hand-held optical probe in the remission geometry. The probe employs diffuse correlation spectroscopy (DCS), a near-infrared optical method that quantifies deep tissue microvascular blood flow. Tumor-to-normal perfusion ratios are derived from thirty-two human subjects. Mean (95% confidence interval) tumor-to-normal ratio using surrounding normal tissue was 2.25 (1.92-2.63); tumor-to-normal ratio using normal tissues at the corresponding tumor location in the contralateral breast was 2.27 (1.94-2.66), and using normal tissue in the contralateral breast was 2.27 (1.90-2.70). Thus, the mean tumor-to-normal ratios were significantly different from unity irrespective of the normal tissue chosen, implying that tumors have significantly higher blood flow than normal tissues. Therefore, the study demonstrates existence of breast cancer contrast in blood flow measured by DCS. The new, optically accessible cancer contrast holds potential for cancer detection and therapy monitoring applications, and it is likely to be especially useful when combined with diffuse optical spectroscopy/tomography.
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Neoplasias da Mama/irrigação sanguínea , Fluxometria por Laser-Doppler/métodos , Microvasos/fisiopatologia , Fluxo Sanguíneo Regional , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Fluxometria por Laser-Doppler/instrumentação , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The Cook-Swartz Doppler has long been a trusted tool for close monitoring of blood flow after microvascular reconstruction; however, device implantation requires additional operating time. Synovis Life Technologies, Inc. received FDA approval in 2010 for the Flow Coupler, which combines an end-to-end anastomotic coupler with a removable 20 MHz Doppler, allowing both procedures to be performed simultaneously. However, its short history of widespread use necessitates further evaluation in the clinical setting. The authors studied the Synovis Flow Coupler in comparison to the more well-established Cook-Swartz Doppler for effectiveness and reliability in detection of vascular compromise. METHODS: The authors reviewed 220 free flap breast reconstructions in 150 patients over a three-year period in which either the Cook-Swartz Doppler or the Synovis Flow Coupler was implanted to monitor blood flow. Outcomes measured include false-positive or false-negative rates (FPR, FNR); rates of OR take-back and salvage; and flap survival. RESULTS: FPR was 1.0% for the Cook-Swartz Doppler and 1.9% for the Synovis Flow Coupler (p>0.05). FNR was 0.0% for both groups. Take-back rates were 10.1% for the Cook-Swartz, and 4.5% for Synovis (p>0.05). Flap failure rates were 1.8% and 0.9% for the Cook-Swartz and Synovis devices, respectively (p>0.05). CONCLUSIONS: Our study reveals no statistically significant differences in outcomes for free flap breast reconstruction where either the Cook-Swartz Doppler or the Synovis Flow Coupler was used to monitor blood flow to the perforator flap. LEVEL OF EVIDENCE: III.
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Retalhos de Tecido Biológico/irrigação sanguínea , Fluxometria por Laser-Doppler/instrumentação , Mamoplastia , Retalho Perfurante/irrigação sanguínea , Anastomose Cirúrgica/instrumentação , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Retalhos de Tecido Biológico/fisiologia , Sobrevivência de Enxerto/fisiologia , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Retalho Perfurante/fisiologia , Período Pós-Operatório , Próteses e Implantes , Fluxo Sanguíneo Regional , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess correlations between maternal serum levels of pro- and anti-angiogenic factors with uterine perfusion in women with early- compared with late-onset preeclampsia, and in healthy pregnant women. DESIGN: Case-control study. SETTING: Antenatal care clinic located within a hospital (São Bernardo do Campo, Brazil). POPULATION: We enrolled 54 preeclamptic and 54 healthy control women who were coming for routine ultrasound at 28-36 weeks' gestation. METHODS: All participants had uterine artery and umbilical Doppler studies and a blood sample to assess maternal serum levels of soluble fms-like tyrosine kinase-1, soluble endoglin, adiponectin and plasminogen activator inhibitor-1. All angiogenic factors were measured using enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Levels of pro- and anti-angiogenic factors in maternal serum, and uterine artery Doppler findings. RESULTS: Concentrations of soluble fms-like tyrosine kinase-1 and soluble endoglin were significantly higher in preeclamptic than control women (p < 0.0001 and p < 0.0001, respectively), especially in those with early-onset (<34 weeks) preeclampsia. These two anti-angiogenic mediators were significantly correlated with increased uterine artery Doppler in the preeclamptic women. Plasminogen activator inhibitor-1 levels were significantly higher in preeclampsia (p = 0.03) but unrelated to uterine artery resistance. Adiponectin levels were similar in cases and controls, independent of body mass index and unrelated to uterine artery resistance. CONCLUSION: Preeclamptic patients have increased soluble fms-like tyrosine kinase-1 and soluble endoglin serum levels and this increase is directly correlated with uterine artery resistance, especially in those with early-onset preeclampsia.
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Fluxometria por Laser-Doppler , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico por imagem , Artéria Uterina/fisiopatologia , Útero/irrigação sanguínea , Resistência Vascular , Adiponectina/sangue , Adolescente , Adulto , Antígenos CD/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Endoglina , Feminino , Idade Gestacional , Humanos , Fluxometria por Laser-Doppler/instrumentação , Inibidor 1 de Ativador de Plasminogênio/sangue , Pré-Eclâmpsia/fisiopatologia , Gravidez , Receptores de Superfície Celular/sangue , Ultrassonografia , Artérias Umbilicais/diagnóstico por imagem , Artéria Uterina/diagnóstico por imagem , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto JovemRESUMO
PURPOSE: To evaluate the efficacy of a technique to preserve the extrinsic vascular supply to the ulnar nerve after transposition and its effect on blood flow and clinical outcome. METHODS: We included 36 patients with cubital tunnel syndrome. The patients were randomly selected to undergo vascular pedicles-sparing surgery for anterior ulnar nerve transposition (VP group) or nerve transposition and artery ligation (non-VP group). Blood flow to the ulnar nerve was estimated intraoperatively at 3 locations in the cubital tunnel before and after transposition using a laser Doppler flowmeter. Clinical results at 3, 6, and 12 months after surgery were also compared between the 2 groups. RESULTS: The blood flow before ulnar nerve transposition was not significantly different between the groups. Blood flow at all 3 locations after the ulnar nerve transposition was significantly higher in the VP group than in the non-VP group. Blood flow in the non-VP group reduced to values between 28% and 52% from the pre-transposition baseline values. After surgery, no significant differences were observed in the clinical results between the groups, except for the Disabilities of the Arm, Shoulder and Hand scores at 12 months after surgery, which was greater in the non-VP group. CONCLUSIONS: The procedure of preserving the extrinsic vascular pedicles can prevent compromise of blood flow to the ulnar nerve immediately after nerve transposition. However, this procedure had no correlation to improved recovery of ulnar nerve function after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
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Síndrome do Túnel Ulnar/cirurgia , Microcirurgia/métodos , Transferência de Nervo/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Nervo Ulnar/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Circulação Colateral/fisiologia , Síndrome do Túnel Ulnar/fisiopatologia , Articulação do Cotovelo/irrigação sanguínea , Desenho de Equipamento , Feminino , Seguimentos , Força da Mão/fisiologia , Humanos , Fluxometria por Laser-Doppler/instrumentação , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Nervo Ulnar/cirurgiaRESUMO
There is an abundance of blood vessels in the oral cavity, and intraoperative bleeding can disrupt operations. There have been some interesting reports about constriction of vessels in the oral cavity, one of which reported that gingival blood flow in cats is controlled by sympathetic α-adrenergic fibres that are involved with vasoconstriction. Dexmedetomidine is a sedative and analgesic agent that acts through the α-2 adrenoceptor, and is expected to have a vasoconstrictive action in the oral cavity. We have focused on the relation between the effects of α-adrenoceptors by dexmedetomidine and vasoconstriction in oral tissues, and assessed the oral mucosal blood flow during sedation with dexmedetomidine. The subjects comprised 13 healthy male volunteers, sedated with dexmedetomidine in a loading dose of 6 µg/kg/h for 10 min and a continuous infusion of 0.7 µg/kg/h for 32 min. The mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), and palatal mucosal blood flow (PMBF) were measured at 0, 5, 10, 12, 22, and 32 min after the start of the infusion. The HR, CO, and PBMF decreased significantly during the infusion even though there were no differences in the SV. The SVR increased significantly but the PMBF decreased significantly. In conclusion, PMBF was reduced by the mediating effect of dexmedetomidine on α-2 adrenoceptors.
Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Dexmedetomidina/farmacologia , Mucosa Bucal/irrigação sanguínea , Vasoconstritores/farmacologia , Adulto , Pressão Arterial/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Sedação Consciente/métodos , Dexmedetomidina/administração & dosagem , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Fluxometria por Laser-Doppler/instrumentação , Masculino , Palato/irrigação sanguínea , Fluxo Sanguíneo Regional/efeitos dos fármacos , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resistência Vascular/efeitos dos fármacos , Adulto JovemRESUMO
BACKGROUND: Despite advances in the monitoring of free flaps, there is still a demand for new technology to detect ischemic complications at an early stage. The aim of the present study was to evaluate the reliability of the O2C-device in terms of detecting flap failure in commonly used perforator flaps for breast reconstruction. METHODS: A total of 34 patients undergoing breast reconstruction were involved in this study. The perfusion dynamics of 23 deep inferior epigastric perforator flaps and 11 superior gluteal arterial perforator flaps were assessed using the O2C-device, which combines a laser light, to determine blood flow (flow), velocity, and white light to determine hemoglobin oxygenation (SO(2)) and relative amount of hemoglobin (rHB). Measurements were carried out intra-operatively after clamping and declamping the perforator vessels. In the post-operative period measurements were carried out every hour for the first 48 hours and from 3rd to 7th for every 2 hours. These dates were compared to findings of clinical assessment. RESULTS: Several intra-operative measurements, during the clamping and declamping the different perforator vessels, revealed a high correlation for all parameters: Flow (r = 0.89, P < 0. 05), Velo (r = 0.92, P < 0. 05), SO2 (r =0.84, P <0. 05), and rHB (r =0.83 P < 0.05). Vessel occlusion was detected in five cases, of which three were due to arterial thrombosis and two further cases were due to venous occlusion. Of the five cases, one flap loss caused by venous occlusion was noted. CONCLUSION: The O2C-device seems to be a reliable, objective, and non-invasive device for the monitoring of free flaps. Thus, it may improve flap survival rates by detecting vascular compromise at an early stage.
Assuntos
Oclusão de Enxerto Vascular/diagnóstico , Cuidados Intraoperatórios/instrumentação , Fluxometria por Laser-Doppler/instrumentação , Mamoplastia/métodos , Monitorização Fisiológica/instrumentação , Retalho Perfurante/irrigação sanguínea , Cuidados Pós-Operatórios/instrumentação , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Cuidados Intraoperatórios/métodos , Modelos Lineares , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Monitorização Fisiológica/métodos , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Espectrofotometria/instrumentação , Trombose/diagnóstico , Trombose/etiologiaRESUMO
BACKGROUND/PURPOSE: The purpose of this study was to investigate the influence of different located post surgical scars on both perfusion and redness. The pattern of change and correlation between perfusion and redness of post surgical scars is also examined. METHODS: In this study, we measured redness and perfusion of the abdominal and breast scar of 24 women undergoing breast reconstruction with Deep Inferior Epigastric Perforator Free Flap surgery with the Minolta Chromameter CR-400/410 and the Moor Instruments laser Doppler imager 12IR, respectively, at different intervals post-operatively. RESULTS: The laser Doppler imager gives significantly higher values for the abdominal compared with the breast scar. There was no consistent correlation found between perfusion and redness at the different test moments for both locations. The scores of both parameters were significantly associated after 9 months follow-up for both locations. CONCLUSION: Scars closed with higher mechanical force show higher perfusion and prolonged activity; and more redness is associated with more perfusion for both post surgical scars. Nevertheless, there was no consistent correlation found between these parameters making the laser Doppler imager and the Colorimeter still non-replaceable instruments.
Assuntos
Mama/fisiopatologia , Mama/cirurgia , Cicatriz/fisiopatologia , Colorimetria/instrumentação , Fluxometria por Laser-Doppler/instrumentação , Imagem de Perfusão/instrumentação , Adulto , Velocidade do Fluxo Sanguíneo , Mama/patologia , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
The aim of this study was to verify the correlation between mean blur rate (MBR) obtained with CCD-equipped laser speckle flowgraphy (LSFG) and capillary blood flow (CBF) obtained by the hydrogen gas clearance method in rabbit optic nerve head (ONH). Using Japanese white rabbits under systemic anesthesia, a hydrogen electrode was inserted an area of the ONH free from superficial capillaries. MBR was measured with LSFG near the hydrogen electrode. CBF and MBR were measured in the range of 32.4-83.5 mL/min/100 g and 3.5-6.0, respectively. MBR and CBF were significantly correlated (r = 0.73, P < 0.01, n = 14). After inhalation of carbon dioxide (CO(2)) or intravenous administration of endothelin-1 (ET-1), MBR and CBF were changed in the relative range of 0.74-1.27 and 0.76-1.35, respectively. The relative changes in MBR and CBF induced by CO(2) and ET-1 were also significantly correlated (r = 0.67, P < 0.01). The current results suggest that MBR may correlate with CBF and also change with CBF, as an index of blood flow in the ONH, linearly.
Assuntos
Capilares/fisiologia , Hidrogênio , Fluxometria por Laser-Doppler , Microcirculação , Nervo Óptico/irrigação sanguínea , Administração por Inalação , Animais , Velocidade do Fluxo Sanguíneo , Capilares/efeitos dos fármacos , Dióxido de Carbono/administração & dosagem , Endotelina-1/administração & dosagem , Gases , Meia-Vida , Hidrogênio/administração & dosagem , Hidrogênio/farmacocinética , Injeções Intravenosas , Eletrodos Seletivos de Íons , Fluxometria por Laser-Doppler/instrumentação , Modelos Lineares , Masculino , Microcirculação/efeitos dos fármacos , Coelhos , Fluxo Sanguíneo Regional , Fatores de TempoRESUMO
OBJECTIVE: The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. STUDY DESIGN: This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bone grafting procedures. In a split-mouth design, noninvasive real-time simultaneous measurements among tissue oxygen saturation (StO2), hemoglobin level (rHb), and blood flow parameters were obtained from normal and alveolar cleft gingiva using spectrophotometry and laser Doppler flowmetry. Subsequent noninvasive capillary density measurements and tissue microangioarchitecture were assessed using sidestream dark-field imaging. RESULTS: There were no significant differences in StO2 and rHb between normal and alveolar cleft gingiva. Blood flow, blood flow velocity, and capillary density were significantly decreased in alveolar cleft gingiva (P < 0.05). CONCLUSIONS: Alveolar cleft reconstructions alter gingival microperfusion properties, and microvascular changes adapt to conserve peak oxygen saturation.