Abstract
The success in microvascular flap transfer depends on the maintenance of optimal perfusion
postoperatively. In addition to anastomosis thrombosis, other perfusion failures such
as venous congestion, spasms, and kinks may appear. As perforator flaps become more
frequent, it must be remembered that perforating vessels are more fragile and susceptible
for trauma and mechanical compression. Sometimes, a flap is doing not well even though
its anastomosis is patent. The flap perfusion can be measured using different tools
in addition to clinical surveillance. We have used microdialysis in monitoring 268
microsurgical flaps and compared the metabolic data of normally perfused flaps to
those that suffered from relative or absolute perfusion failure. We found that tissue
glucose and lactate concentrations and especially their relation (lactate-to-glucose
ratio) can show the presence of ischemia and aid in decision making, whether to reoperate
or not. High lactate-to-glucose ratio may also predict total or partial flap necrosis.
Keywords
microvascular flap - microdialysis - metabolism
