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Near infrared spectroscopy; A novel application of INVOS™ for monitoring muscle only free flaps

Published:August 25, 2020DOI:https://doi.org/10.1016/j.bjps.2020.08.071
      Free microvascular tissue transplantation has become the gold standard for reconstruction in defects ranging from head and neck cancer, breast reconstruction and significant limb injuries. Flap failure rates are below 5% with increased risk of complication and failure in head and neck and lower limb trauma. Complications can still be common including vascular compromise leading to flap necrosis and complete flap loss. Free flaps where vascular compromise is detected and explored early, have good salvage rates with some centres reporting up to 92%.
      • Chang E.
      • Mehrara B.
      • Festekjian J.
      • et al.
      Vascular complications and microvascular free flap salvage: the role of thrombolytic agents.
      Clinical assessment encompassing capillary refill, turgor, and audible Doppler signal by adequately trained staff, is the gold standard, but this is dependent on considerable experience, and is even more difficult when assessing muscle free flaps. Muscle flaps are a particular problem when it comes to venous congestion and run a higher risk of delay before recognition of a problem.
      • Dat A.
      • Loh I.
      • Bruscino-Raiola F.
      Free-flap salvage: muscle only versus skin paddle – an Australian Experience.
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      References

        • Chang E.
        • Mehrara B.
        • Festekjian J.
        • et al.
        Vascular complications and microvascular free flap salvage: the role of thrombolytic agents.
        Microsurgery. 2011; 31: 505-509
        • Dat A.
        • Loh I.
        • Bruscino-Raiola F.
        Free-flap salvage: muscle only versus skin paddle – an Australian Experience.
        ANZJ Surg. 2016; 87: 1040-1043
        • Fischer G.W.
        • Silvay G.
        Cerebral oximetry in cardiac and major vascular surgery.
        HSR Proc Intens Care Cardiovasc Anesth. 2010; 2: 249-256
        • Kim S.
        • Shin H.
        • Lee S.
        "Internet of Things" real-time free flap monitoring.
        J Craniofac Surg. 2018; 29: 22-25
        • Zoccali G.
        • Molina A.
        • Farhadi J.
        Is long term post-surgical monitoring of free flaps still necessary?.
        J Plast Reconstr Aesthet Surg. 2017; 70: 996-1000