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DIEP flap perfusion assessment using microdialysis versus Doppler ultrasonography: A comparative study
Michail Sorotos1, Guido Firmani1, Roberta Tornambene2
1Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy.
Microsurgery
|August 4, 2023
Summary
Microdialysis monitoring of adipocutaneous flaps offers superior early detection of vascular complications compared to external Doppler ultrasonography. This method aids in reducing flap ischemia times and unnecessary reoperations, improving patient outcomes.
Area of Science:
- Plastic Surgery
- Microsurgery
- Vascular Monitoring
Background:
- Buried free-tissue transfer procedures require objective methods for evaluating vascular complications.
- Microdialysis, using interstitial biological markers, has emerged as a monitoring technology, primarily for muscular flaps.
- This study focuses on adipocutaneous flaps, comparing microdialysis with external Doppler ultrasonography (EDU) for early postoperative monitoring.
Purpose of the Study:
- To compare the efficacy of external Doppler ultrasonography (EDU) versus microdialysis in the early postoperative follow-up of adipocutaneous flaps.
- To propose an efficient and objective postoperative monitoring protocol for free flaps.
- To evaluate the utility of glucose and lactate concentrations, and their ratio, in assessing flap viability.
Main Methods:
- A retrospective assessment of 68 DIEP flaps (50 patients) from January 2019 to March 2021.
- Standardized postoperative monitoring included clinical signs, EDU, and microdialysis.
- Ischemic trend thresholds were defined as glucose <1 mmol/L and lactate >6 mmol/L; a Glucose/Lactate ratio was calculated as a novel viability parameter.
Main Results:
- Two flaps required reoperation due to identified vascular impairment, with only one total flap necrosis, yielding a 2.94% reoperation rate and 98.53% success rate.
- External Doppler ultrasonography demonstrated 100% sensitivity and 82% specificity.
- Microdialysis showed 100% sensitivity and 100% specificity for detecting vascular compromise.
Conclusions:
- Microdialysis provides earlier indication of flap viability than EDU, establishing it as a valuable postoperative monitoring tool.
- Utilizing specific thresholds for glucose and lactate, along with the Glucose/Lactate ratio, can help prevent unnecessary re-explorations.
- This approach can significantly reduce flap ischemia times and improve surgical outcomes.
