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Related Experiment Videos

Microdialysis detects postoperative perfusion failure in microvascular flaps.

Leena Setälä1, Anthony Papp, Eeva-Liisa Romppanen

  • 1Department of Plastic Surgery, Kuopio University Hospital, Finland.

Journal of Reconstructive Microsurgery
|February 4, 2006
PubMed
Summary

Microdialysis (MD) offers a reliable method for monitoring microvascular flap perfusion, detecting thrombosis earlier than clinical observation. This technique improved flap salvage rates and overall success in microvascular reconstruction.

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Area of Science:

  • Plastic Surgery
  • Vascular Surgery
  • Biomedical Engineering

Background:

  • Postoperative monitoring of microvascular flaps is crucial due to anastomotic failure risks.
  • Clinical observation is the standard for detecting perfusion failure, but its reliability is debated.
  • Advanced techniques are sought for more accurate and timely diagnosis of flap compromise.

Purpose of the Study:

  • To evaluate the efficacy of microdialysis (MD) in monitoring microvascular flap perfusion postoperatively.
  • To compare MD findings with clinical observations in detecting perfusion abnormalities and anastomotic thrombosis.
  • To assess the impact of MD monitoring on flap salvage and success rates.

Main Methods:

  • Microdialysis (MD) was used to assess in situ tissue metabolism in 80 consecutive microvascular flaps.

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  • Metabolic parameters (glucose and lactate concentrations) were continuously monitored.
  • Alarm levels for glucose and lactate were established to guide clinical decisions and reoperation.

    • Main Results:

    • Microdialysis accurately identified 13 cases of anastomosis thrombosis (9 arterial, 4 venous) by detecting decreased glucose (< 2.7 mmol/l) and increased lactate (> 5.7 mmol/l).
    • MD indicated pathological trends hours before clinical signs in some instances.
    • The flap salvage rate was 77% for thrombosed flaps, with a 95% overall success rate in microvascular reconstruction.

    Conclusions:

    • Microdialysis is a clinically feasible and sensitive method for monitoring all types of microvascular flaps.
    • MD is particularly valuable when clinical observation is difficult or impossible.
    • On-line MD monitoring prevented flap loss due to delayed diagnosis of secondary ischemia.