D-dimer level monitoring in the early postoperative observation of island flap blood supply

Abstract

Objective To evaluate the clinical value of monitoring D-dimer level in the early postoperative observation of island flap blood supply. Methods A prospective controlled clinical study was performed with 28 patients who underwent island flap transfer for coverage of soft tissue defect of the hand from July 2013 to July 2015. There were 25 male patients and 3 female patients whose ages ranged from 13 to 56 years. D-dimer level was measured 24, 48 and 72 hours postoperatively in all the patients, who were divided into the crisis group (n=12) and the control group (n=16) based on whether there was vascular crisis. The D-dimer values were compared between groups and among various postoperative time points. Results D-dimer level in the crisis group went up continuously. There were significant differences among the values measured at 24, 48 and 72 hour postoperative time points (P<0.05). In the control group, D-dimer level was found to have risen significantly from 24 hours to 48 hours postoperatively (P=0.002), but not from 48 hours to 72 hours (P=0.074). There was no statistically significant difference between D-dimer values of the crisis group and of the control group at 24 hours postoperatively (P=0.511). However D-dimer levels in the crisis group were significantly higher than those in the control group at 48 and 72 hour postoperative time points (P=0.032, P=0.003). Conclusion Monitoring the D-dimer level is of certain value for identifying vascular crisis at the early postoperative stage after island flap transfer. It can be used to guide medication adjustment and implementation of interventions to rescue the flap. Key words: Finger injuries; Surgical flaps; D-dimer; Flap crisis