Results of monitoring fasciocutaneous, myocutaneous, osteocutaneous and perforator flaps: 4-year experience with 166 cases

International Journal of Oral and Maxillofacial Surgery
Frank HölzleK D Wolff

Abstract

Four free-flap types were compared regarding perioperative blood perfusion parameters and to define critical values for success. 166 cases were investigated: radial forearm flap (fasciocutaneous, n=89); fibula flap (osteocutaneous, n=32); ALT flap (myocutaneous, n=25); soleus perforator flap (n=20). All flaps were monitored with simultaneous laser-Doppler flowmetry and tissue spectrophotometry intra- and postoperatively up to 14 days. In 24 (15%) of 166 cases perfusion irregularity occurred. Operative exploration was performed in 12 cases (9 successful). 11 flaps (5 radial forearm, 3 fibula, 2 ALT, 1 perforator) were lost due to vascular compromise, which led to an overall success rate of 93%. Rapid increase in haemoglobin concentration of >30% identified venous congestion. Abrupt decline of blood flow and haemoglobin oxygenation indicated arterial occlusion. For radial forearm flaps haemoglobin oxygenation of 15% and a deep flow of 20 AU were identified as minimum values for flap viability. For fibula, ALT, and perforator flaps haemoglobin oxygenation of 10% and a deep flow of 15 AU were determined as the minimum values. This non-invasive technique was an accurate method for evaluating viability of free-flaps.

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Citations

Mar 12, 2011·Intensive Care Medicine·Thomas W L Scheeren
Feb 14, 2013·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Thomas MückeKlaus-Dietrich Wolff
Jan 12, 2016·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Klaus-Dietrich WolffAndreas M Fichter
Mar 1, 2012·International Journal of Oral and Maxillofacial Surgery·Y LiuR H Shi
Dec 14, 2011·Annales de chirurgie plastique et esthétique·F LangeJ Yachouh
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Mar 26, 2010·International Journal of Oral and Maxillofacial Surgery·D ChubbM W Ashton
Jan 21, 2012·Microsurgery·Thomas MückeTimm Steiner
Apr 20, 2011·Microsurgery·Thomas MückeKlaus-Dietrich Wolff
Nov 28, 2012·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·René JonasJürgen Hoffmann
Jun 24, 2017·Journal of Stomatology, Oral and Maxillofacial Surgery·K-D Wolff
Aug 25, 2016·Plastic and Reconstructive Surgery·Shinsuke AkitaKaneshige Satoh
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Feb 3, 2015·Annals of Plastic Surgery·Jay GranzowJ Brian Boyd
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