Abstract
to validate an experimental model for the measurement of glycemic levels in surgical flaps with the use of common glucometers, and to analyze the diagnostic criteria for hypoperfusion of such flaps. we performed vertical myocutaneous rectus abdominis flaps with upper pedicles bilaterally in 20 male Wistar rats, divided into two groups: with and without venous occlusion of the pedicle. We measured glucose levels in the flaps and in the systemic circulation with standard glucometers. We tested the accuracy of alternative diagnostic criteria for the detection of hypoperfusion. from 15 minutes of venous occlusion on, there was a significant reduction in glucose levels measured in the congested flap (p<0.001). Using a minimum difference of 20mg/dl in the glycemic levels between the flap and systemic blood, 30 minutes after occlusion, as a diagnostic criterion, the sensitivity was 100% (95% CI 83.99-100%) and specificity of 90% (95% CI 69.90-97.21%) for the diagnosis of flap congestion. It is possible to measure glucose levels in vertical myocutaneous rectus abdominis flaps of Wistar rats, perfused or congested, using a common glucometer. The diagnostic criteria that compare the glucose levels in the flaps with the systemic ones were more accurate in the evaluation of tissue perfusion.
Highlights
One of the most common complications of flap surgery is the occlusion of the pedicle vessels with subsequent necrosis of the flap, which occurs in 3% to 7% of cases, even with advanced surgical techniques[1,2,3,4,5,6,7,8]
Systemic glucose remained stable throughout the experiment in all animals
Using the difference between flap and systemic glucose levels with a cutoff value of 20mg/dl, the sensitivity was 100% and the specificity of 90%
Summary
One of the most common complications of flap surgery is the occlusion of the pedicle vessels with subsequent necrosis of the flap, which occurs in 3% to 7% of cases, even with advanced surgical techniques[1,2,3,4,5,6,7,8]. Many methods have been tested with the aim of obtaining the early diagnosis of hypoperfusion, capable of allowing an objective evaluation by other, non-specialist professionals. Among these evaluations are temperature measurement, Doppler flowmetry, transcutaneous oximetry, and tissue glucose and metabolic levels[6,7,9,10,11,12,13,14,15,16]. The common glucometer, which uses a drop of blood, is a low-cost method for measuring glucose and is readily available in most hospital units It is an easy, fast, objective and inexpensive method to measure glycemic levels
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