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Variables Affecting Postoperative Tissue Perfusion Monitoring In Abdominal Based Free Flaps
Cemile Nurdan Ozturk, Can Ozturk, Wayne Ledinh, Mehmet Bozkurt, Steven Bernard, Graham Schwarz, Risal Djohan
Cleveland Clinic, Plastic Surgery Department
2013-03-14
Presenter: Wayne Ledinh
Affidavit:
The material has not been published in any scientific journal or previously presented.
Director Name: James E Zins
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Tissue oxygen saturation measurement (TOx) with near-infrared spectrophotometry (NIRS) is one of the methods employed to aid postoperative free flap monitoring. The aim of this study was to investigate the variables that effect tissue oximetry.
Methods: Flap TOx was prospectively recorded with near infrared spectrophotometry (NIRS) prior to extubation, after extubation and every four hours for thirtysix hours. At the same time points blood SO2 (pulse oximetry), amount of supplemental oxygen and blood pressure were recorded. Change in TOx with time was analyzed and was correlated to above variables. The pre-extubation TOx value was correlated to intraoperative measurements.
Results: Thirty two flaps (DIEP, MS-TRAM, TRAM and SIEA) were monitored for this study. Initially, a significant trend over time was detected such that for every increase of 24 hours, TOx decreased on average by 2.1% (p=0.025). However, when accounting for SO2 levels, this decrease was no longer significant (p=0.19). An increase by 1% in SO2 produced an increase in TOx reading of 0.36 (p=0.007). The amount of supplemental O2 and blood pressure did not have a significant impact on TOx (p>0.05). Pre-extubation flap TOx readings were correlated to surgical variables. The readings were highest in free TRAM and were lower in decreasing order in MS-TRAM, DIEP and SIEA flaps. The TOx values did not show relation to recipient or flap vessel size, perforator number or perforator row.
Conclusion: The postoperative fluctuations in flap saturation were found to be correlated to blood oxygen saturation, and not dependent on perforator number or vessel caliber.
