Role of Lactate Measurement in Flap Monitoring: An Useful Adjunct

Area of Science:

• Plastic Surgery
• Surgical Monitoring
• Biomedical Engineering

Background:

• Vascular compromise in flaps presents a significant challenge for reconstructive surgeons.
• Objective and reliable postoperative flap monitoring is crucial for timely salvage procedures.
• This study investigates the utility of flap capillary lactate in predicting flap viability within 48 hours post-surgery.

Purpose of the Study:

• To determine if flap capillary lactate levels can predict flap viability.
• To establish a reliable, objective method for postoperative flap monitoring.
• To assess the association between lactate levels and flap survival.

Main Methods:

• Capillary lactate values were assessed in flaps with accessible skin paddles at multiple time points (0, 1, 6, 12, 24, and 48 hours).
• Clinical observation was used concurrently to evaluate flap viability.
• Statistical analysis, including receiver operating characteristic (ROC) curve analysis, was performed to determine significance and cutoff values.

Main Results:

• A total of 30 patients (25 males, mean age 45.03) were included, undergoing either free or pedicled flaps.
• A highly significant association was found between clinical observation and flap outcome.
• Mean lactate values differed significantly between survived (5.32 ± 1.91 mmol/L) and ischemic flaps (8.38 ± 1.81 mmol/L), with a cutoff value of 6.09 mmol/L indicating flap survival.

Conclusions:

• Flap capillary lactate measurement is a valuable, objective tool for assessing flap viability.
• This method is easy, quick, and cost-effective for postoperative flap monitoring.
• Lactate monitoring can aid surgeons in timely interventions for compromised flaps.