Sir,
We read with interest the recent article by Bulstrode et al.
1.
regarding a no-touch technique for surface temperature monitoring of free flaps. Temperature monitoring with a probe is accepted as a useful tool in assessment of free flap viability when the clinical situation involves re-implantation of distal amputated parts or transfers of low tissue volume. Surface temperature recording (STR) has been suggested as a useful monitoring tool where flap pallor or cyanosis is difficult to ascertain. We would, however, like to urge caution when interpreting the surface temperature in isolation.We recently performed a free DIEP flap post-mastectomy breast reconstruction in a 46-year-old Asian lady. Zone 4 of the flap was discarded as per usual practice and her immediate post-operative course was uneventful. During the post-operative monitoring period, regular STR and clinical observations were made and charted. We subsequently found that, despite significant clinical deterioration of the lateral portion of the free flap, the surface temperature readings did not significantly change compared with adjacent non-flap skin (Fig. 1, Fig. 2) . Subsequently surgical intervention revealed full thickness flap necrosis.
The surface temperature of a flap reflects a balance between the rate of heat gained by conduction and convection and heat lost as thermal energy.
2
Temperature recordings are, therefore, influenced by many factors not directly related to the flap perfusion, for example, the use of heat lamps, warming blankets and the ambient temperature of room. The lack of temperature difference of our flap and the surrounding skin was most likely due to heat gained by conduction from the surrounding tissue.While we agree that STR may be a useful tool for monitoring free flaps, our case re-emphasises the need for associated clinical judgement.
References
- No touch free-flap temperature monitoring.BJPS. 2002; 55: 174
- Monitoring of free flaps with surface temperature recordings: is it reliable?.Plast Reconstr Surg. 1992; : 495-499
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© 2003 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.
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