Monitoring bei freien Lappenplastiken und Replantationen. Eine Bestandsaufnahme im deutschsprachigen Raum

Abstract

The risk of total flap loss after free microvascular tissue transfer is estimated to be between 2 and 6 %. According to the literature the main reason for flap loss is thrombosis of the anastomosis. The percentage of successful revision is decreasing depending on the time period between circulatory failure and its detection. For this reason postoperative monitoring has been developed. The focus of interest was the question if there are generally accepted principles for postoperative flap monitoring. This research focused on finding standards for postoperative monitoring methods. Further topics of interest were surgical technique, anticoagulation, decision criteria for revision, the use of technical support and monitoring plans. Therefore all 150 members of the Society for Microsurgery in the German-speaking countries Austria, Germany and Switzerland received a questionnaire. 74 out of 150 surgeons answered and returned the questionnaire (49.3 %). Only a minority of responders use couplers routinely for anastomosis with only 10.3 %, whilst 89.7 % use conventional anastomosis. 65.6 % of the surgeons use heparin for the anastomosis, 45.6 % of them systemically. 44.1 % continue a systemic use of heparin postoperatively. We could show that monitoring and decision for revision is done for clinical reasons. Altogether only 29.4 % use technical support for monitoring. The Doppler US is used most often by 16.2 % for routine use, followed by licox pO (2) sensor by 5.9 % and the thermo-sensor by 4.4 %. Most common postoperative interval for monitoring is (43.1 %): every hour until day 3, every second hour until day 5 and decreasing intervals until discharge from the hospital. A well-working anastomosis is obligatory for successful free microvascular tissue transfer. Most of the surgeons perform hand-made anastomosis. We could show that monitoring and decision for revision is mainly for clinical reasons. Most commonly in use for technical support was the Doppler US method for accessing flap viability.