Constant infusion fluorometry to predict flap survival

Prediction of surgical flap survival in a dog model was evaluated by using the technique of fluorometry. The model provides a graded variation of flap ischemia with tissue necrosis occurring at the distal end. The indicator sodium fluorescein was administered via the saphenous vein at a constant infusion rate for 20 minutes. Quantitative fluorescence measurements were obtained with surface illumination of the flap at 132 sites for 15 flaps in the five animals. Wash-in slopes and wash-out clearances, both measures of tissue perfusion, were compared with the survival of flap regions observed at seven days. The sensitivity and specificity of fluorometric wash-in and wash-out measurements were compared in their ability to predict flap survival. The study showed sensitivities of 100% and 95% and specificities of 97% and 86%, respectively for the two methods. The wash-in procedure with constant infusion may be preferable to the wash-out technique since it requires less time to complete. In addition, it avoids bolus injections thus reducing the risk of anaphylactoid reactions.