RESUMO
Free flap monitoring is essential to the early detection of compromise thereby increasing the chance of successful salvage surgery. Many alternatives to classical clinical monitoring have been proposed. This study seeks to investigate a relatively new monitoring technology: near infrared spectroscopy (NIRS). Patients were recruited prospectively to the study from a single center. During the research period, 10 patients underwent reconstruction with a free deep inferior epigastric perforator flap (DIEP). Measurements of flap perfusion were taken using NIRS in the preoperative and intraoperative phases and postoperatively for 72 hours. NIRS showed characteristic changes in all cases which returned to theater for pedicle compromise. In these cases, NIRS identified pedicle compromise prior to clinical identification. There were no false-positives. NIRS accurately identified all compromised flaps in our study. In most cases, there was an evidence of changes in oxygen saturation on NIRS prior to clinical observation. Further research, ideally double blind randomized control trials with large sample groups would be required to definitively establish NIRS as an ideal flap monitoring modality.
Assuntos
Artérias Epigástricas/transplante , Mamoplastia/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Sobrevivência de Tecidos , Músculos Abdominais/irrigação sanguínea , Músculos Abdominais/transplante , Adulto , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Coortes , Artérias Epigástricas/cirurgia , Feminino , Seguimentos , Rejeição de Enxerto/prevenção & controle , Humanos , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Mastectomia/métodos , Microcirculação/fisiologia , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Consumo de Oxigênio/fisiologia , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Reino UnidoRESUMO
A syndrome now known as Ehlers-Danlos, comprising laxity and fragility of the skin associated with hypermobility of the large joints, was published in 1892 by Tschernogobow. Ehlers-Danlos type VIIA is an extremely rare form of the syndrome. While the UK-based Ehlers-Danlos Support Group recommends that the surgical management of patients with Ehlers-Danlos VIIA should be carried out in conjunction with a plastic surgeon, there is nothing in the plastic surgery literature regarding this syndrome. The management of patients suffering from Ehlers-Danlos VIIA is highly complex, as a result of the breadth of genetic and phenotypic presentations, and resulting complications. We present a review of the literature regarding this syndrome and, in particular, the surgical problems that may be encountered. A case report outlining our experience of successfully managing this condition is also presented.