Floor plan - 2013 Annual Meeting - American Association for Hand ...

Buried flap monitoring using a novel non-invasive simultaneous microcirculatory perfusion,
oxygenation and venous outflow monitor
Institution where the work was prepared: Hannover Medical School, Hannover, Germany
Karsten Knobloch, MD, PhD; Andreas Gohritz; Niels C. Gellrich; Peter M. Vogt; Hannover Medical School
INTRODUCTION:
Buried microsurgical flaps into the local skin provide an excellent soft tissue augmentation in facial reconstruction, but is hampered by
the fact that methods of flap monitoring are pending. A method for early identification of microcirculatory perfusion complications in
these tissue transplants seems indispensable for a successful long-term outcome.
OBJECTIVE:
To present the feasibility of real-time microcirculatory mapping for capillary flow, tissue oxygen saturation and postcapillary venous filling
pressures using a quantitative non-invasive Laser-Doppler-Spectrophotometry (Oxygen-to-see, 02C) of free flaps .
METHODS:
We report the use of this system in a 24-year-old patient who required complex facial reconstruction following orbital evisceration and
hemifacial atophy caused by radiation therapy during childhood due to retinoblastoma. For soft tissue augementation a split latissimus
dorsi muscle flap was transplanted to the frontal zygomatic region subcutaneously and anastomosed to the facial vessels.
Microcirculatory parameters of blood flow, flow velocity, postcapillary venous filling pressures (AU, Arbitrary Units) and oxygen saturation
(S02%) were assessed prospectively at five positions around both orbitae.
RESULTS:
Capillary blood flow was increased superficially at all five positions up to the 40-fold preoperative value (3AU/120AU). Deep capillary
blood flow was increased in all five positions more than 4-fold (85AU/354AU). Baseline periorbital microcirculation markedly differed
preoperatively with reduced S02% and capillary blood flow and increased postcapillary venous filling pressures. S02% at a superficial
and deep level was increased up to fivefold level at the 6th day postoperatively (16%/82%). Postcapillary venous filling pressures were
increased in 3/5 positions superficially up to 40% (37AU/61AU) and 3/5 positions at 8mm up to 13% following flap transfer
(162AU/184AU). The flap survival was 100%.
CONCLUSION:
Free flap monitoring using the Oxygen-to-see Laser-Doppler-Spectrophotometry offers quantitative microcirculatory values for intraand
postoperative perfusion control. Tissue oxygenation is increased following buried flap transfer with transient increase of postcapillary
venous filling pressure without clinical deterioration of the buried flap.
Local Perforator Flaps Around the Elbow
Institution where the work was prepared: Recovery Hospital, Cluj-Napoca, Romania
Alexandru Georgescu, Prof, MD, PhD; Ileana Matei; Filip Ardelean, MD; UMF Iuliu Hatieganu
INTRODUCTION:
The advancements in knowledge about the blood supply of tissues induced the surgeons to imagine new types of flaps, the last one
described being the perforator flaps. This paper will try to demonstrate that around the elbow it is better to harvest flaps based on brachioradial
musculocutaneous perforators or on the inferior cubital artery. The advantage of using these flaps is the possibility for early
post-surgery mobilization.
MATERIALS/METHODS:
In this paper we will present 7 cases of perforator flaps around the elbow, from which 2 harvested on the posterior aspect, one on the
distal third of the forearm and the rest on the anterior aspect (on the elbow’s flexion fold and the proximal third of the forearm). The
patients were aged between 2 and 35 years. Three flaps were based on musculocutaneous perforators from the brachioradialis muscle,
three were based on the inferior cubital artery (the most important perforator vessel emerging from the radial artery) and one on
the recurrent radial artery. In the absence of the Doppler pre-surgery investigations, the harvesting technique consisted of: - initial incision
on two thirds of the flap’s circumference - subfascial undermining until the perforator is detected - completion of the flap’s incision
and deep dissection - the flap’s pedicle is undermined inside the muscle or septum The flap’s length is 2 cm larger then the defect’s
length. In 5 of the 7 cases the donor site was directly sutured, in 2 cases we used split skin grafts.
RESULTS:
The post-surgery mobilization was early, without affecting the flap’s viability. All the flaps survived without any suffering.
CONCLUSIONS:
The perforators emerging from the proximal third of the forearm, especially the musculocutaneous ones and the inferior cubital artery
are able to sustain the blood supply for flaps as wide as 100 cmÇ, used to cover anterior and posterior defects in the elbow area.
191