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Monitoring of free TRAM flaps with microdialysis
A Udesen1, E Løntoft, S R Kristensen
1Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark.
Journal of Reconstructive Microsurgery
|March 8, 2000
Summary
Microdialysis monitoring of free TRAM flaps revealed significant metabolic changes during ischemia, including decreased glucose and increased lactate and glycerol. This technique effectively detects flap compromise, enabling early intervention.
Area of Science:
- Biochemistry
- Surgical Innovation
- Tissue Metabolism
Background:
- Free TRAM flap reconstruction is a common procedure.
- Monitoring flap viability post-surgery is crucial.
- Existing methods for assessing flap health can be limited.
Purpose of the Study:
- To evaluate the utility of microdialysis for real-time metabolic monitoring of free TRAM flaps.
- To assess glucose, glycerol, and lactate levels in flaps compared to a subcutaneous reference.
- To determine if microdialysis can detect early signs of flap ischemia or failure.
Main Methods:
- Microdialysis catheters were placed in free TRAM flaps and subcutaneously in the femur of 15 patients.
- Dialysate was collected for 72 hours postoperatively.
- Concentrations of glucose, glycerol, and lactate were measured and compared between flap and control sites.
Main Results:
- During ischemia, flaps showed significantly reduced glucose and increased lactate and glycerol levels compared to controls.
- Metabolite levels normalized after reperfusion.
- A flap that failed due to arterial thrombosis exhibited a complete drop in glucose, a transient lactate increase, and a sharp rise in glycerol.
Conclusions:
- Microdialysis is a valuable tool for early detection of ischemia in free TRAM flaps.
- Metabolic monitoring via microdialysis can facilitate timely surgical intervention.
- This technique offers a sensitive method for assessing flap viability.