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The 72-Hour Microcirculation Dynamics in Viable Free Flap Reconstructions.

Nicholas Moellhoff1, Clara Gernert1, Konstantin Frank1

  • 1Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany.

Journal of Reconstructive Microsurgery
|February 14, 2022
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Summary

Continuous monitoring of free flaps reveals increased blood flow and decreased oxygenation post-transfer. Understanding these perfusion dynamics aids early detection of vascular compromise and improves flap survival.

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Area of Science:

  • Microsurgery
  • Vascular Surgery
  • Tissue Engineering

Background:

  • Vascular complications pose the highest risk within 24 hours of free flap transfer.
  • Delayed recognition of critical perfusion signs can impede flap salvage.
  • Understanding physiological perfusion dynamics is crucial for early detection of failing flaps.

Purpose of the Study:

  • To investigate the physiological perfusion dynamics of viable free flaps.
  • To utilize the Oxygen to See (O2C) device for continuous monitoring.

Main Methods:

  • Continuous microcirculation monitoring in 85 viable free flaps for up to 72 hours post-anastomosis.
  • Utilized tissue spectrophotometry and laser Doppler flowmetry (O2C device).
  • Investigated parameters: blood flow, oxygen saturation (SO2), and relative hemoglobin (rHB).

Main Results:

  • Significant increase in microcirculatory blood flow, peaking around 18 hours post-anastomosis.
  • Mean oxygen saturation (SO2) showed a decreasing trend, with the steepest decline between 3-6 hours.
  • Relative hemoglobin (rHB) values remained relatively constant.

Conclusions:

  • Post-free flap transfer hyperemia leads to increased microvascular flow.
  • Reduced tissue oxygenation is likely due to increased oxygen consumption after anastomosis.
  • Improved understanding of perfusion dynamics aids early recognition of compromised vasculature and enhances free flap salvage.