Principles of Microvascular Surgery.
Principles of Microvascular Surgery.
Principles of Microvascular Surgery.
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Monitoring perfusion<br />
• Temperature monitoring -<br />
» First described by Baudet, PRS 1976.<br />
» Good for skin or skin island flaps.<br />
» Unreliable in free muscle flaps.<br />
» Khouri & Shaw, PRS 1992 -<br />
• Series <strong>of</strong> 600 consecutive free flaps.<br />
• Monitored the temp difference between the flap and a<br />
control site.<br />
• Detected 52 thrombosed flaps - 45 salvaged.<br />
» Jones, PRS 1992 -<br />
• Pulse oxymeter is better for replanted digit.<br />
• Good only for skin that can be monitored more easily by<br />
capillary refill and Doppler probes.<br />
Monitoring perfusion<br />
• Implantable ultrasonic Doppler -<br />
» Direct monitoring.<br />
» Distinguish between arterial and<br />
venous occlusion.<br />
» More reliable than thermocouple<br />
probe.<br />
» Disa, Cordiero & Hidalgo, PRS<br />
1999 -<br />
• 750 free flaps, 673 nonburied.<br />
• Flap loss - 2.3%.<br />
• Buried flap loss - 6.5%, non were<br />
salvaged in reexploration.<br />
• The use <strong>of</strong> Implantable Doppler is<br />
recommended in buried flaps.<br />
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