Flap and finger-tip blood glucose level monitoring to predict venous thrombosis in free flaps: a simple and effective method

Manish Jain; Saurabh Garg; Dinesh Yadav; Sanjay Sharma

doi:10.18203/2320-6012.ijrms20231430

Authors

Manish Jain Department of Plastic and Reconstructive Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
Saurabh Garg Department of Plastic and Reconstructive Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India https://orcid.org/0000-0003-3510-2464
Dinesh Yadav Department of Surgical Oncology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
Sanjay Sharma Department of Surgical Oncology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231430

Keywords:

Flaps monitoring, Blood glucose level monitoring, Flap salvage

Abstract

Background: Rapid detection and early re-exploration is the key to salvage congested flap. Various methods have been described in literature to monitor flaps in post operative period. We evaluate the efficacy of measurement of flap and fingertip blood glucose level and its role in predicting the flap congestion and salvage.

Methods: prospective observational study conducted in a tertiary care centre in North India between December 2020 to December 2022. A total of patients 500 underwent 507 free tissue transfer were included in this study. Flap congestion was noted clinically in 41 flaps. In these 41 flaps, flap and fingertip blood glucose level were measured.

Results: Congested appearing flaps divided into 2 groups. Group A consist of 8 flaps out of 41. The difference in flap and fingertip blood glucose level is less than 10%. Out of 8, 5 does not required re-exploration and were successfully salvaged. In 3 flaps, difference in flap and fingertip glucose level rises with time and were taken for re-exploration. Out of these 3, 2 were successful salvaged. Group B consist of 31 flaps. In these 31 flaps, 41. the difference in flap and fingertip blood glucose level is more than 10%. All these flaps were re-explored and 21 were salvaged.

Conclusions: Flap and body glucose level monitoring is a simple and reliable method for flap monitoring and it can be performed by residents as well as nursing staff.

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References

Smit JM, Zeebregts CJ, Acosta R, Werker PMN. Advancements in free flap monitoring in the last decade: a critical review. Plast Reconstr Surg. 2010;125:117e85.

Qian Y, Li G, Zang H. A systematic review and meta-analysis of free-style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open. 2018;6(02):e1651.

Hyodo I, Nakayama B, Kato H. Analysis of salvage operation in head and neck microsurgical reconstruction. Laryngoscope. 2007;117(02):357-60.

Brown JS, Devine JC, Magennis P, Sillifant P, Rogers SN, Vaughan ED. Factors that influence the outcome of salvage in free tissue transfer. Br J Oral Maxillofac Surg. 2003;41(01):16-20.

Miyasaka M, Ichikawa K, Nishimura M. Salvage operations of free tissue transfer following internal jugular venous thrombosis: a review of 4 cases. Microsurgery. 2005;25(03):191-5.

Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg. 1994;9303:472-78.

Kroll SS, Schusterman MA, Reece GP. Choice of flap and incidence of free flap success. Plast Reconstr Surg. 1996;98(03):459-63.

Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique Plast Reconstr Surg. 1998;10203:722-32.

Yang Q, Ren Z H, Chickooree D et al. The effect of early detection of anterolateral thigh free flap crisis on the salvage success rate, based on 10 years of experience and 1072 flaps. Int J Oral Maxillofac Surg. 2014;43(09):1059-63.

Ho M W, Brown J S, Magennis P. Salvage outcomes of free tissue transfer in Liverpool: trends over 18 years (1992-2009). Br J Oral Maxillofac Surg. 2012;50(01):13-8.

Novakovic D, Patel R S, Goldstein D P, Gullane P J. Salvage of failed free flaps used in head and neck reconstruction. Head Neck Oncol. 2009;1:33.

Chae MP, Rozen WM, Whitaker IS, Chubb D, Grinsell D, Ashton MW et al. Current evidence for postoperative monitoring of microvascular free flaps: A systematic review. Ann Plast Surg. 2015;74:621‑32.

Okazaki M, Asato H, Takushima A, Sarukawa S, Nakatsuka T, Yamada A. Analysis of salvage treatments following the failure of free flap transfer caused by vascular thrombosis in reconstruction for head and neck cancer. Plastic Reconstructive Surg. 2007;119:1223-32.

Leena P, Maj-Len KE, Markku A. Glucose, lactate, and pyruvate response in an experimental model of microvascular flap ischemia and reperfusion. Microsurgery. 2004;24:223e31.

Sakakibara S, Hashikawa K, Omori M, Terashi H, Tahara S. A simple method of flap monitoring. J Reconst Microsurg. 2010;26:433e4.

Hara H, Mihara M, Iida T, Narushima M, Todokoro T, Yamamoto T et al. Blood glucose measurement for flap monitoring to salvage flaps from venous thrombosis. J Plast Reconstr Aesthet Surg. 2012;65:616‑9.

Karakawa R. Ratio of blood glucose level change measurement for flap monitoring. Plast Reconstr Surg Glob Open. 2018;6:e:1851-7.