Role of flap blood glucose measurement in monitoring of flap incorporating skin and to detect flap congestion and flap salvage

Abstract

Background: Flap surgery has become a reliable method of reconstruction of postsurgical and posttraumatic defects almost over any part of the body with vascularized tissue. Complications associated with flap surgeries may lead to partial or total flap failure. Scrupulous postoperative flap monitoring allows early detection of flap failure which is the only evidence-based strategy for optimizing free flap salvage. There are various methods available for flap monitoring. Classical clinical observation of the flap requires clinical expertise. Microdialysis is a method that measures certain metabolites like glucose, lactate, etc., levels in the flap blood which is objective, reliable, and reproducible method. Based on the principles of microdialysis, monitoring of capillary glucose levels in flaps using glucometer is being proposed as a cheap, rapid, and simple method for the early prediction of microvascular complications and thereby reducing flap failure. Aims: The aim was to study blood glucose levels in flaps incorporating skin in comparison to control site to correlate flap blood glucose level with clinical changes in these flaps. Settings and Design: A hospital-based observational study was conducted on twenty patients operated for reconstruction with flaps in a tertiary hospital setup in Manipur during the period of December 2017 to November 2019. Statistical Analysis: The data were analyzed with IBM SPSS statistics 21 developers. Descriptive statistics mean were used for statistical analysis and paired t-test for quantitative data. P Results: Out of total twenty patients studied, 10 patients (50%) were in the age group of 30–50 years. Total 14 flaps (70%) were pedicled and 6 (30%) were free flaps. Total 4 flaps (20%) had complications (venous thrombosis) in the first 24 h, three flaps were pedicled and one flap was free flap. Flap capillary glucose level drops when there was venous thrombosis otherwise flap capillary glucose level fluctuates according to capillary blood glucose level of control area. Conclusions: The measurement of free flap capillary glycemia may be used as a method of diagnosis of complications which is a simple and rapid method of flap monitoring. It can help in flap salvage but it is not superior to clinical evaluation by an experienced professional for the detection of venous thrombosis.