Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

详细信息    查看全文

• 作者：Iain Stuart Whitaker ; Zita Maria Jessop…
• 关键词：Flap monitoring ; Free flap ; Clinical assessment ; Flap assessment ; Flap management
• 刊名：European Journal of Plastic Surgery
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：38
• 期：2
• 页码：123-126
• 全文大小：115 KB
• 参考文献：1. Smit, JM, Zeebregts, CJ, Acosta, R, Werker, PM (2010) Advancements in free flap monitoring in the last decade: a critical review. Plast Reconstr Surg 123: pp. 177-185 CrossRef
  2. Chubb D, Whitaker IS, Rozen WM, Grinsell D, Ashton MW, Lineaweaver WC (2012) Evidence for postoperative monitoring of microvascular free flaps: a systematic review. Ann Plast Surg 2012
  3. Whitaker, IS, Karoo, ROS, Oliver, DW, Ganchi, PA, Gulati, V, Malata, CM (2005) Current techniques in the post-operative monitoring of microvascular free-tissue transfers. Eur J Plast Surg 27: pp. 315-321 CrossRef
  4. Chubb, D, Rozen, WM, Whitaker, IS, Acosta, R, Grinsell, D, Ashton, MW (2010) The efficacy of clinical assessment in the postoperative monitoring of free flaps: a review of 1140 consecutive cases. Plast Reconstr Surg 125: pp. 1157-1166 CrossRef
  5. Khouri, RK, Cooley, BC, Kunselman, AR, Landis, JR, Yeramian, P, Ingram, D (1998) A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 102: pp. 711-721 CrossRef
  6. Bui, DT, Cordeiro, PG, Hu, Q-Y, Disa, JJ, Pusic, A, Mehrara, BJ (2007) Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 119: pp. 2092-2100 CrossRef
  7. Chen, K-T, Mardini, S, Chuang, DC-C, Lin, C-H, Cheng, M-H, Lin, Y-T (2007) Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 120: pp. 187-195 CrossRef
  8. Hofer, SOP, Damen, THC, Mureau, MAM, Rakhorst, HA, Roche, NA (2007) A critical review of perioperative complications in 175 free deep inferior epigastric perforator flap breast reconstructions. Ann Plast Surg 59: pp. 137-142 CrossRef
  9. May, JW, Chait, LA, O’Brien, BM, Hurley, JV (1978) The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg 61: pp. 256-267 CrossRef
  10. Smit, JM, Acosta, R, Zeebregts, CJ, Liss, AG, Anniko, M, Hartman, EHM (2007) Early reintervention of compromised free flaps improves success rate. Microsurgery 27: pp. 612-616 CrossRef
  11. Smit, JM, Zeebregts, CJ, Acosta, R (2008) Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 122: pp. 991-992 CrossRef
  12. Whitaker, IS, Gulati, V, Ross, GL, Menon, A, Ong, TK (2007) Variations in the postoperative management of free tissue transfers to the head and neck in the United Kingdom. Br J Oral Maxillofac Surg 45: pp. 16-18 CrossRef
  13. Whitney, TM, Lineaweaver, WC, Billys, JB, Siko, PP, Buncke, GM, Alpert, BS (1992) Improved salvage of complicated microvascular transplants monitored with quantitative fluorometry. Plast Reconstr Surg 90: pp. 105-111 CrossRef
  14. Kind, GM, Buntic, RF, Buncke, GM, Cooper, TM, Siko, PP, Buncke, HJ (1998) The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg 101: pp. 1268-1275 CrossRef
  15. Goldberg, J, Sepka, RS, Perona, BP, Pederson, WC, Klitzman, B (1990) Laser Doppler blood flow measurements of common cutaneous donor sites for reconstructive surgery. Plast Reconstr Surg 85: pp. 581-586 CrossRef
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Plastic Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1435-0130

文摘

Background Monitoring the microcirculation postoperatively has been the subject of numerous original articles and reviews since the early 1980s. Effective monitoring returns compromised flaps to the operating room early, increases the flap success and reduces secondary complications. We would like to present the case based on our experiences that clinical monitoring alone is sufficient for the majority of patients. Methods Using a retrospective case note review, we present the experiences of the senior surgeon (DG) in his first 592 consecutive free tissue transfers in practice. Results The overall success rate was 98.9?% (585/592) with an overall salvage rate of 93?% (13/14). Conclusions Clinical monitoring provides sufficient reassurance in the majority of patients undergoing free tissue transfers. We believe that buried flaps and flaps to the lower limb may warrant adjunctive monitoring techniques on a case-by-case basis. Level of Evidence: Level IV, diagnostic study.