Microcirculation in DIEP flaps: a study of the haemodynamics using laser Doppler flowmetry and lightguide reflectance spectrophotometry

Abstract

This paper gives us some useful information on the dynamics of the microcirculation following flap transfer. It also complements what we know about the vascular anatomy, and more particularly the venous anatomy of the DIEP flap. 1 Blondeel P.N. Arnstein M. Verstraete K. et al. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg. 2000; 106: 1295-1299 Google Scholar While some of these changes may be intuitive, this paper makes the important contribution of documenting those changes. For example, an initial reduction in blood flow is something that we have appreciated in flap transfer, whether pedicled or free. There are many potential explanations for this. Vessel spasm as well as the effects of vaso-active peptides can explain some of these changes. 2 Zhang J. Lipa J.E. Black C.E. Huang N. Neligan P.C. Ling F.T. et al. Pharmacological characterization of vasomotor activity of human musculocutaneous perforator artery and vein. J Appl Physiol. 2000; 89: 2268-2275 Google Scholar What is particularly interesting is that a difference was noted between the flaps that went on to uncomplicated wound healing and outcome versus those that got into trouble. There is the potential to use this information as a means of monitoring outcomes. There may also be the potential to use this information to help make the clinical decision, for example, to do another vein. Perhaps a critical drop in flow below an arbitrary number may be a useful indicator. Maybe we should be using LRS readings to guide us in this decision-making. The fact that the one flap in this series with a large caliber deep venous drainage system recovered more quickly shows the importance of venous drainage in the equation of microcirculatory circulation. The authors are to be congratulated for drawing our attention to this subject and it is hoped that further studies will help define the role this information may ultimately play in clinical decision making in flap surgery. Microcirculation in DIEP flaps: a study of the haemodynamics using laser Doppler flowmetry and lightguide reflectance spectrophotometryJournal of Plastic, Reconstructive & Aesthetic SurgeryVol. 59Issue 6PreviewThe deep inferior epigastric perforator (DIEP) flap is ideally suited for breast reconstruction. The DIEP flap reduces abdominal wall morbidity when compared to a transverse rectus abdominis (TRAM) flap, however, there maybe a compromise of the flap vascularity. Early venous problems and late fat necrosis in DIEP flaps can occur. There is a limited literature on the haemodynamic and microcirculation of the DIEP flap. Sixteen consecutive patients who underwent immediate breast reconstruction with DIEP flap were prospectively monitored during the post-operative time for a minimum period of 48 h using laser Doppler flowmetry (LDF) and lightguide reflectance spectrophotometry (LRS) to analyse blood flow and oxygenated haemoglobin percentage in the cutaneous microcirculation of the flap. Full-Text PDF