ABSTRACT
In microvascular tissue transfers, it is essential postoperatively to follow-up on
the perfusion of the transferred flap because of the risk of anastomotic failure.
The diagnosis of pedicle obstruction is usually made by clinical observation, but
some techniques have been reported as more reliable than clinical observation in detecting
perfusion failure. The authors used microdialysis (MD), a method developed to assess
in situ tissue metabolism, in the follow-up of 80 consecutive microvascular flaps
from October, 2001 to October, 2003. Of the 78 flaps with postoperative data, 58 flaps
were uneventful clinically and using MD, and served as the reference material for
normal postoperative metabolism. Twenty flaps showed some abnormality in the clinical
course or with MD. Of these, 13 flaps were reoperated for anastomosis thrombosis (9
arterial, 4 venous). All thromboses were clearly recognized by MD via a decrease in
the glucose concentration in the tissue (< 2.7 mmol/l) and an increase in the lactate
concentrations (> 5.7 mmol/l). In some cases, MD indicated a pathological trend in
glucose and lactate concentrations hours before there were any clinical signs. A system
of alarm levels was developed for the staff: when the limits were reached, a critical
evaluation of the situation was undertaken, and the need for reoperation was considered.
In the series, the salvage rate of all thrombosed flaps was 77 percent, with a final
success rate in microvascular reconstruction of 95 percent. No flap was lost due to
a delay in the diagnosis of secondary ischemia, if on-line MD monitoring was available.
Microdialysis is a clinically feasible and sensitive monitoring method for all kinds
of microvascular flaps, especially for those in which clinical observation is difficult
or impossible. The performance of the analysis is easy and can be done by even less
experienced nursing staff working in institutes with a low frequency of microsurgery.
KEYWORDS
Microdialysis - microvascular - monitoring
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Leena SetäläM.D. Ph.D.
Department of Plastic Surgery 2214, Kuopio University Hospital
P.O. Box 1777, 70211 Kuopio, Finland
