Buried Flaps Research Articles

Cook-Swartz Doppler Probe Surveillance for Free Flaps-Defining Pros and Cons.

Introduction The main postoperative complication of free flaps is perfusion compromise. Urgent intervention is critical to increase the chances of flap survival. Invasive flap perfusion monitoring with direct blood flow feedback through the Cook–Swartz Doppler probe could enable earlier detection of perfusion complications. Materials and Methods Between 2012 and 2016, 35 patients underwent breast reconstruction or defect coverage after trauma with a deep inferior epigastric perforator, anterolateral thigh, transverse musculocutaneous gracilis, gracilis, or latissimus dorsi flap in our department. All flaps were monitored with a Cook–Swartz probe for 10 days postoperatively. The 20 MHz probe was placed around the arterial–venous anastomosis. A flap monitoring protocol was established for standardized surveillance of postoperative perfusion. In the event of probe signal loss, immediate surgical revision was initiated. Results Signal loss was detected in 8 of the 35 cases. On return to the operating room, six were found to be true positives (relevant disruption of flap perfusion) and two were false positives (due to Doppler probe displacement). There were also two false negatives, resulting in a slowly progressive partial flap loss. Flap perfusion was restored in three of the six cases (50%) identified by the probe. Following surgical intervention, three of the six cases had persistent problems with perfusion, resulting in two total flap losses and one partial flap necrosis leading to an overall 5.7% total flap loss. Conclusion Postoperative flap perfusion surveillance is a complex matter. Surgical experience is often helpful but not always reliable. The costs, false-positive, and false-negative rates associated with invasive perfusion monitoring with Cook–Swartz probe make it most appropriate for buried flaps. Level of Evidence This is an original work.

Buried island transposition flap for joint Plastic-Neurosurgical management of spinal wound dehiscence – a technical note and single Centre experience

Introduction Spinal surgical wound infection can lead to tissue voids between the spine and skin that can be difficult to reconstruct. Previously described techniques include myocutaneous flaps or perforator based fasciocutaneous flaps. However, these procedures can be time-consuming and surgically challenging. Aims This study aimed to assess the effectiveness of a novel technique employing a buried island transposition (BIT) flap, for the repair of non-irradiated dehisced spinal wounds. Methods Fifteen patients with failed conservative management of infected midline posterior spinal wounds, underwent wound repair using a local buried islanded de-epithelialized double-breasted fasciocutaneous transposition flap, performed by joint input from the neurosurgical and plastic surgical teams. Results Mean age was 58 years (range, 31–76 years) with male-to-female ratio of 8:7. The BIT flap was used to repair four wounds in the cervical spine with underlying fixation; four wounds in the thoracic spine with underlying fixation; and seven wounds in the lumbar-sacral spine, of which three had underlying fixation. Pre-operatively, each of the wounds were either dehiscent with exposed hardware, or had large defects unsuitable for primary closure following debridement. There was no procedure-related mortality. All patients demonstrated good wound healing with no subsequent repeat surgery or removal of spinal fixation at mean 24-month follow-up. Conclusion We successfully used a novel buried island transposition flap that has not previously been described in repair of spinal wounds. This technique, which led in all cases to good wound healing and prevented removal of metalwork, has comparable efficacy but increased ease of use compared to traditional techniques. It requires redundant skin at the wound site.

Microdialysis in postoperative monitoring of microvascular free flaps: Experiences with a decision algorithm

BackgroundReconstruction with free flaps has become a usual practice in maxillofacial surgery. Clinical monitoring is still the standard approach for postoperative follow-up, but can be difficult or impossible with intraorally situated or buried flaps. Microdialysis is a sampling technique that offers the possibility to monitor the metabolism of flaps continuously. It is a reliable method for early diagnosis of ischemia. Materials and methods48 microvascular free flaps applied following oral cancer resection were monitored with a microdialysis (MD) catheter, placed in the flap. Glucose, lactate, and lactate/pyruvate ratio were monitored using a bedside analyser for 5 days. 48 free flaps served as controls and were assessed (refill, flap temperature, and color) by clinical monitoring (CM). Results12 flaps monitored by MD showed abnormal metabolism and underwent revision. Eight flaps were saved and four were lost within the first 5 days postoperatively. In addition, two flaps were lost at days 15 and 30 postoperatively, without previous complications. Four flaps assessed by CM developed complications, underwent revision, and were saved. In addition, five flaps were lost between the 8th and 23rd days postoperatively, without revision, due to missing previous clinical signs. ConclusionPostoperative monitoring of free flaps using a microdialysis decision algorithm allows early diagnosis of anastomotic complications. It is a clinically feasible and sensitive monitoring method for microvascular flaps, allowing surgical revision to be undertaken before clinical alteration takes place.

Novel technique to manage pacemaker exposure with buried flap reconstruction: case series

ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly...

Modern postoperative monitoring of free flaps.

Flap failure in microvascular reconstruction is a costly complication with total flap loss being the worst-case scenario. With the aim to rapidly identify a postoperative circulatory problem, some susceptible flaps can be saved by careful clinical monitoring or by various technical monitoring methods. In head and neck surgery, where the flaps are often buried and difficult to monitor clinically, a reliable technical monitoring method would be useful. A broad range of different techniques are in use varying according to practical and personal preferences among clinics and surgeons. However, no evidence for any particular technique being superb has emerged. We review reports of some frequently used and modern free flap monitoring techniques. Clinical monitoring is still the gold standard to which other techniques are compared to. Laser Doppler flowmetry and near-infrared spectroscopy have been reported to identify early circulatory problems, but both techniques are not well suited for buried flaps. Implantable Doppler, flow coupler, partial tissue oxygen pressure and microdialysis are invasive monitoring methods suitable for buried flaps. More research with practical and clinically relevant parameters, that is flap salvage rate, false positive rate and cost-efficiency are needed before objective comparisons between different monitoring techniques can be made.

A novel technique for clinical examination of buried head and neck free flaps

Monitoring buried flaps within the head and neck presents a unique challenge to the microsurgeon. We conducted an independent review of the literature using Medline, PubMed and Q Read performed up to February 2017. This showed that head and neck free flaps have contemporary success rates of between 92 and 98%, which is similar to rates reported for all types of flaps (90–98%). Studies looking specifically at buried free flaps were scarce, with success rates (90–98%) precisely mirroring those of studies looking at all flaps. In studies in which both buried and non-buried flaps were stratified, buried flaps did have lower rates of success (93.5 vs. 98.2% and 93 vs. 98%). While overall success rates may have been similar, lower rates of salvage were clearly shown for buried flaps. Salvage rates ranged from 0 to 75%. The highest rate was achieved using implantable Doppler, which has been shown to increase salvage rates by up to 21%. However, this technique is associated with significant rates of false positives, which have been shown to be between 8 and 40.4% Another monitoring technique in use for buried flaps was externalised monitoring segments, which has been associated with higher rates of pharyngeal fistula in head and neck reconstruction. In this article, we present a variation of the Acland’s empty-and-refill test which may be used to monitor buried flaps that have a venous anastomosis in an end-to-end fashion to the external jugular vein. Level of Evidence: Level IV, diagnostic study.

A Novel Application of Double-Paddle Peroneal Chimeric Flap as External Sentinel Monitor in Hypopharyngeal Reconstruction

Monitoring the viability of buried free flaps in hypopharyngeal reconstruction is difficult. Various methods have been proposed to monitor these buried flaps, but limitations remain. We present a method of using double-paddle chimeric peroneal flaps that permanently externalizes a flap skin paddle as a monitoring paddle in hypopharyngeal reconstructions. This study was performed in a medical center in southern Taiwan; between 2013 and 2015, 10 patients underwent double-paddle chimeric peroneal flap reconstruction in advanced stages of hypopharyngeal cancer. We retrospectively reviewed the medical records from these surgeries, searching for either short-term postoperative complications or long-term follow-up morbidity and researched relevant articles for comparisons with other monitoring methods. None of the 10 flaps underwent total loss. The rate of stenosis and that of fistula formation was 10%. The average postoperative hospital stay was 39 days. Six of 10 patients were able to resume at least a soft diet after reconstruction, and none of the patients experienced significant complications. The peroneal flap is a useful flap because it is thin and pliable, has minimal donor site morbidity in patients without peripheral vascular disease, and has the potential of multiple skin paddles so that one skin paddle can be used for monitoring the buried flap. Using this method, direct clinical monitoring is feasible, and early detection of vascular complications is possible. Furthermore, the drawbacks of using a monitoring paddle produced by a deepithelialized bridge can be avoided.

Indocyanine green applications in plastic surgery: A review of the literature

Use of indocyanine green (ICG) near-infrared fluorescence as a dye to assess tissue vascularization is now well standardized. The aim of this literature review was to review and resume the most recent recommendations for ICG use in its plastic surgery applications. A systematic literature review was performed using Medline, EMBASE, and PubMed databases to obtain the latest recommendations for ICG in plastic surgery. Inclusion criteria were all articles written in English language that evaluated pre-, intra-, or postoperative ICG applications in surgical procedures usually performed by plastic surgeons. Case reports, reviews, meta-analyses, and experimental studies on animals or cadavers were excluded after title and abstract screening. Of the 1389 article titles retrieved, 41 full-text articles met the inclusion criteria. ICG applications in plastic surgery were ICG lymphangiography used in sentinel lymph node mapping for breast cancer and melanoma and in microsurgery for the staging and treatment of secondary chronic lymphedema. The latest updates of ICG angiography in assessing free flaps, pedicled flaps, or large skin paddles were also retrieved. Large prospective studies suggest that ICG lymphography could be used as a single tracer to reliably perform sentinel lymph node biopsy. In the case of cutaneous melanoma, ICG lymphography increases node detection sensitivity and accuracy in conjunction with lymphoscintigraphy. In chronic lymphedema, it is useful for pre- and postoperative staging and intraoperative anatomical location of lymphatic pathways when lymphovenous bypass is indicated. ICG angiography is used intraoperatively to assess free flap anastomosis and design skin paddles and postoperatively to monitor buried flaps. In pedicled perforator flaps or for large skin paddles, intraoperative ICG angiography is strongly correlated with postoperative outcomes. 3.

Buried free flaps in head and neck reconstruction: higher risk of free flap failure?

Thrombosis of the pedicle is central to free flap failure, and early revision of a compromised flap is the key to successfully salvage a flap. Therefore, the majority of free flaps in reconstructive head and neck surgery are used with the ability to visually examine the flap. Sometimes, due to intra-operative circumstances, it is necessary to use a flap that cannot be monitored externally. These flaps are called buried flaps and have the reputation of being put at risk. The current literature provides only limited data to support or disprove this position. A single institution retrospective review of patient charts between 2007 and 2015 was performed. Flap monitoring was carried out with hand-held Doppler of the pedicle hourly for the first 72h in all cases. Additional duplex ultrasound was performed in the majority of buried flaps. A total of 437 flaps were included into the study. 37 flaps (7.8%) were identified to fulfill the criteria of a buried free flap. In total, four patients had complications, three of which required operative reexploration. All interventions were successful, resulting in no flap loss in our series. An accurate operation technique combined with meticulous monitoring protocols supported by duplex ultrasound can result in satisfactory outcome of buried flaps. No enhanced risk of flap loss of buried flaps was found in our cohort.

Contrast enhanced ultrasound (CEUS) - an unique monitoring technique to assess microvascularization after buried flap transplantation.

Incidence of patients requiring complex soft tissue or osseous reconstruction has dramatically increased. However most of the monitoring systems have limitations in tissue penetration and are not able to detect microvascular complications after transplantation of so-called buried-flaps, that have no contact to the surface.Aim of the study was to assess contrast enhanced ultrasound (CEUS) as monitoring tool after buried flap transplantations. 20 patients were examined after buried flap transplantation using CEUS. Quantitative perfusion analysis (TIC) was performed with an integrated perfusion software using stored cine-loops. Two perfusion-parameters, time to PEAK (TtoPk) and area under the curve (Area), were evaluated using TIC analysis. Minor complications were observed in 3 patients. In these patients a delayed contrast agent wash-in and wash-out was observed. Additionally the perfusion values TtoPk (sec.) and Area (relative Units) were clearly different in the patients with minor complications: TtoPk: 32.0 sec; Area 425.5 rU (without complication), TtoPk: 38.6 sec.; Area: 18.3 rU (wound healing disturbance) and TtoPk: 14.4 sec.; Area: 105.9 rU (hematoma). As CEUS can assess microvascularization almost depth-independent, CEUS is an unique method to assess global flap perfusion after buried flap transplantation.

Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

Monitoring the microcirculation postoperatively has been the subject of numerous original articles and reviews since the early 1980s. Effective monitoring returns compromised flaps to the operating room early, increases the flap success and reduces secondary complications. We would like to present the case based on our experiences that clinical monitoring alone is sufficient for the majority of patients. Using a retrospective case note review, we present the experiences of the senior surgeon (DG) in his first 592 consecutive free tissue transfers in practice. The overall success rate was 98.9 % (585/592) with an overall salvage rate of 93 % (13/14). Clinical monitoring provides sufficient reassurance in the majority of patients undergoing free tissue transfers. We believe that buried flaps and flaps to the lower limb may warrant adjunctive monitoring techniques on a case-by-case basis. Level of Evidence: Level IV, diagnostic study.

Rationale for the use of the implantable Doppler probe based on 7 years’ experience

In head and neck microvascular reconstruction, a proportion of patients are at a higher risk of flap failure. These include salvage surgery after chemoradiotherapy, reconstruction for osteoradionecrosis and when difficulty is encountered in achieving flap perfusion intraoperatively. Several studies have shown that the Cook-Swartz Doppler (Cook Medical Inc, Bloomington, USA) enabled earlier detection of a compromised flap. We retrospectively reviewed microvascular reconstructions monitored with the Cook-Swartz implantable Doppler (2006–2012) and included patients’ characteristics, comorbidity (American Society of Anesthesiologists’ (ASA) grade), indication for operation, type of reconstruction, and indication for implantable Doppler. We also included details of surgical exploration, free flap salvage, and outcomes of flap salvage. These outcomes were compared with a group of low-risk patients (2005–2009) whose flaps were monitored clinically. A total of 75 free flaps in 73 patients were monitored with the implantable Doppler: 40 (53%) were in cases which required reconstruction following previous surgery/radiotherapy or flap perfusion difficulties, 10 (13%) buried flaps, 13 (17%) as routine flap monitors and 12 (17%) for other indications. The false negative rate was 5%, sensitivity 67%, the false positive rate was 25%, and specificity was 95%. Higher risk flaps monitored with the doppler had a higher return to theatre rate, 21% compared with 4% (p<0.001) and flap failure rate, 7% compared with 1% (p=0.002). Salvage rates for free flaps were similar in both groups (62% compared with 60%, p=1.0). There is not enough evidence to suggest that the implantable doppler reduces the rate of failed flaps in routine low-risk cases, and its value in monitoring high-risk reconstructions require evaluation in a prospective randomised study.

Use of Scar and Capsule Flap for Preventing the Contour Deformity After Applying Tissue Expansion in Patients With Scar

Tissue expansion is a reconstruction method often used to repair the tissue loss that results after removing soft tissue lesions such as scars, tumors, and giant hairy nevi. However, because the pressure of a tissue expander applies in all directions almost equally, along with the desired expansion of skin and subcutaneous fat tissue, the muscle and bone underneath the expander become depressed simultaneously. Even with a successful expansion of the tissue itself, the conventional surgical procedure results to frequent aesthetically dissatisfying outcomes because of contour irregularities. However, no studies have been conducted regarding the correction of these secondary deformities. A surgical method to prevent secondary depression deformity was performed on a total of 80 patients who had undergone scar revision using tissue expansion between May 2002 and April 2012. First, the scar tissue was de-epithelized and transposed to fill the depressed area as a buried flap. Second, the capsule formed around a tissue expander was elevated as a flap and turned over to fill the depressed area. Lastly, the thickened capsule at the margins of the expander was used as a free capsule graft, which provides additional supports. Four plastic surgeons analyzed the postoperative aesthetic results after the surgery in an outpatient follow-up clinic. There were complications of tissue expansion in 7 patients: 5 had minor complications, which were successfully addressed with conservative treatments, and 2 had major complications, which required tissue expander removal during the course. In more than 85% of the patients, satisfactory postoperative aesthetic results were achieved without any perceivable depression or asymmetry. Secondary depression deformity induced by a tissue expander can be effectively prevented with a simple operative technique using capsule flaps, scar tissue flaps, and free capsule grafts.

Venous Occlusion Detected by Caregiver with Implantable Doppler in a Buried Free Flap.

The use of the implantable Doppler device eases the burden of free flap monitoring, and allows caregivers to notify healthcare personnel of a potential vascular event. A 24-year-old female patient underwent anterolateral thigh adipofascial flap surgery to provide a buried flap on the left temporal area for a depressed and infected skull wound. The author was able to salvage the flap from two venous occlusions, which was made possible by early notifications from the caregiver who reported changes in the Doppler signal.

A chimaeric-pattern flap design for implantable Doppler surrogate monitoring: A novel placement technique

Postoperative flap monitoring is a vital aspect of free tissue transfer in order to detect early vascular compromise and to enable early flap salvage. The implantable Doppler monitoring system is one of many monitoring devices used to ensure accuracy and reduce unnecessary flap explorations. However, there are a number of concerns with its use, namely tension on the anastomosis, possible vessel constriction and false-negative detection. This study aimed to alleviate these concerns, by introducing a new method of placing the implantable Doppler probe on the adjacent vessel limb of a chimaeric flap. This is illustrated by a case series of chimaeric free tissue flaps that allow this surrogate placement of the Doppler probe. The flap is raised in a chimaeric fashion, with a main perforator pedicle to the skin or muscle paddle for the main reconstructive purpose and a side branch from the main pedicle going to a smaller adipofascial or muscle flap for monitoring. This branch vascular pedicle leading to the chimaeric tissue is kept sufficiently long to enable placement of the Doppler cuff and prevent turbulence. The probe of a Cook-Swartz implantable Doppler system is placed around the branch pedicle, approximately 5 mm from the branching point, and secured with a vessel clip. This is then secured away from the major vessels of the main free flap. Removal of the probe's crystal and wire is easily done with a single gentle traction on postoperative day 7. Five cases of chimaeric free flaps were performed with this manoeuvre: three thoracodorsal perforator chimaeric flaps for head-and-neck or extremity reconstruction, one latissimus dorsi neuromuscular chimaeric flap for facial reanimation and one digastric lymph node transfer for the treatment of lower limb lymphoedema. The Doppler system showed a low but sustained oscillating flow in all cases indicating vascular patency, with minimal flow interference from other large-calibre vessels. There was no discernible kinking on the anastomosis. There were no complications encountered during probe removal. This postoperative monitoring manoeuvre was done successfully with good results. The monitoring equipment is very sensitive to any flow disturbance due to positional changes in the head-and-neck region or the extremities and is able to detect flow changes in buried flaps postoperatively. Chimaeric flap composition is easier now than before because of perforator-oriented pedicle dissection, and surrogate Doppler monitoring is one more application of the chimaeric flap. This novel chimaeric fashion of implantable Doppler probe placement is a good surrogate measure of flow in the main pedicle.

Buried Flap Reconstruction after Nipple-Sparing Mastectomy

Recent evolutions of oncologic breast surgery and reconstruction now allow surgeons to offer the appropriate patients a single-stage, autologous tissue reconstruction with the least donor-site morbidity. The authors present their series of buried free flaps in nipple-sparing mastectomies as proof of concept, and to explore indications, techniques, and early outcomes from their series. From 2001 to 2011, a total of 2262 perforator-based free flaps for breast reconstruction were reviewed from the authors' prospectively maintained database. There were 338 free flaps performed on 215 patients following nipple-sparing mastectomy, including 84 patients who underwent breast reconstruction with 134 buried free flaps. Ductal carcinoma in situ and BRCA-positive were the most common diagnoses, in 26 patients (30.9 percent) each. The most common flaps used were the deep inferior epigastric perforator (77.6 percent), transverse upper gracilis (7.5 percent), profunda artery perforator (7.5 percent), and superficial inferior epigastric artery flaps (3.7 percent). An implantable Cook-Swartz Doppler was used to monitor all buried flaps. Fat necrosis requiring excision was present in 5.2 percent of breast reconstructions, and there were three flap losses (2.2 percent). Seventy-eight flaps (58.2 percent) underwent minor revision for improved cosmesis; 56 (41.8 percent) needed no further surgery. Nipple-sparing mastectomy with immediate autologous breast reconstruction can successfully and safely be performed in a single stage; however, the authors are not yet ready to offer this as their standard of care. Therapeutic, IV.

Vastus Lateralis Muscle Flaps for Monitoring Buried Anterolateral Thigh Flaps

Postoperative monitoring of buried anterolateral thigh flaps is difficult with standard methods. Although a monitoring skin flap based on a second cutaneous perforator is often used, it requires tedious dissection of 2 sets of perforators and cannot be used when a second perforator is absent. We present 2 patients who underwent head and neck reconstruction with buried anterolateral thigh flaps, which were monitored with a small, externalized segment of the vastus lateralis muscle accompanying the main skin island. Both flaps survived, and the monitoring muscle flaps remained pink throughout the postoperative period until removal. For monitoring, a vastus lateralis muscle flap has several advantages over a skin flap. This method obviates the need for dissecting a second cutaneous perforator and allows reliable monitoring regardless of the number of available cutaneous perforators. We believe this method is a versatile option for monitoring buried anterolateral thigh flaps.

Monitoring a buried flap: Endoscopic pinpric test

MicrosurgeryVolume 33, Issue 3 p. 247-248 Letter to the Editor Monitoring a buried flap: Endoscopic pinpric test Si̇nan Öksüz M.D., Corresponding Author Si̇nan Öksüz M.D. [email protected] Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeyGülhane Askeri Tıp Akademisi, Haydarpasa Eğitim Hastanesi, Plastik Rekonstrüktif ve Estetik Cerrahi Servisi, Tıbbiye Cad. Üsküdar, İstanbul, TurkeySearch for more papers by this authorHüseyi̇n Karagöz M.D., Hüseyi̇n Karagöz M.D. Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeySearch for more papers by this authorFi̇kret Eren M.D., Fi̇kret Eren M.D. Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeySearch for more papers by this authorErsi̇n Ülkür M.D., Ersi̇n Ülkür M.D. Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeySearch for more papers by this author Si̇nan Öksüz M.D., Corresponding Author Si̇nan Öksüz M.D. [email protected] Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeyGülhane Askeri Tıp Akademisi, Haydarpasa Eğitim Hastanesi, Plastik Rekonstrüktif ve Estetik Cerrahi Servisi, Tıbbiye Cad. Üsküdar, İstanbul, TurkeySearch for more papers by this authorHüseyi̇n Karagöz M.D., Hüseyi̇n Karagöz M.D. Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeySearch for more papers by this authorFi̇kret Eren M.D., Fi̇kret Eren M.D. Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeySearch for more papers by this authorErsi̇n Ülkür M.D., Ersi̇n Ülkür M.D. Burn Unit, Department of Plastic Reconstructive and Aesthetic Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, İstanbul, TurkeySearch for more papers by this author First published: 19 December 2012 https://doi.org/10.1002/micr.22073Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume33, Issue3March 2013Pages 247-248 RelatedInformation

Monitoring in microvascular tissue transfer by measurement of oxygen partial pressure: Four years experience with 125 microsurgical transplants

In a prospective study, the characteristics and benefit of an invasive measurement of oxygen partial pressure (pO2) with the aid of a polarographic sensor were investigated in 125 microsurgical reconstructions of the head and neck area over a period of 45 months. Measurements were performed over 96 h in eight different types of microsurgically revascularized flaps for extra- and intraoral reconstructions and were evaluated separately for each flap type.Of 125 reconstructions the system indicated malperfusion in 18 cases. Salvage surgery was performed in 17 cases due to venous thrombosis (6 cases), arterial thrombosis (3 cases), a combination of arterial and venous thrombosis (2 cases), rheological problems (3 cases), venous insufficiency by hematoma (2 cases) and kinking of vessels (1 case). In 10 cases salvage surgery was successful, 7 flaps were lost despite salvage surgery. In all these cases, the polarographic probe indicated the necessity of salvage surgery correctly. After 96 h no malperfusion was seen. Postoperatively, a common and characteristic development of the oxygen partial pressure in different types of flaps was seen. Initially, a clear increase of pO2 could be measured. During 96 h, a slow decrease of pO2 was observed.In conclusion polarographic measurement of pO2 can be an excellent apparative supplement for the postoperative clinical control of microsurgically revascularized transplants. In buried flaps, this technique represents the only reliable method for transplant monitoring.

Buried free flaps in head and neck surgery: Outcome analysis

Over the last several decades, reconstruction of the head and neck oncologic defect has been revolutionized by the use of microvascular free tissue transfer. The majority of these defects can be reconstructed with the ability to visually monitor the flap, to intervene as soon as vascular compromise becomes evident. Occasionally, it is necessary to use a flap that has no visual external monitor: a buried free flap. A belief has circulated within the microvascular community that buried free flaps do not do as well as visible flaps. By our review, there are no recent data in the literature to support this position. We present our data on the outcomes of buried free flaps in microvascular reconstruction. A single institutional retrospective review of 1492 flaps was performed between January 1999 and December 2011. A total of 103 free flaps (7.2%) were identified as meeting the criteria for a buried flap. It should be noted that all flaps with or without an external segment were monitored with an implantable Doppler. The flap failure and complications are defined as those failures or complications occurring within 2 weeks of surgery and related to the operation or to the flap itself. In all, 5 of the 103 patients (4.9%) had complications requiring reoperative intervention. There were no instances of flap failure within the first 2 weeks of surgery. In our series, there are no differences in flap failure rates comparing buried flaps to externally monitored flaps.