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"INVOS" WE TRUST. Tissue Oximetry for Free Flap Monitoring in Lower Limb Reconstruction
Manuel Fernández Garrido1, Laura Torrano2, Jordi Riba2
1Department of Plastic and Reconstructive Surgery, Hospital Clinic Barcelona, Universitat de Barcelona, Barcelona, Spain.
Microsurgery
|March 4, 2025
Summary
Regional tissue oximetry (rSO₂) monitoring improves lower limb free flap salvage by enabling faster detection of complications. This objective, non-invasive method significantly speeds up flap revision surgeries compared to traditional clinical evaluation.
Area of Science:
- Plastic Surgery
- Microsurgery
- Biomedical Engineering
Background:
- Free flaps are crucial for lower limb salvage, preventing amputation.
- Regional tissue oximetry (rSO₂) offers objective, real-time flap perfusion assessment.
- Current literature primarily focuses on rSO₂ for breast flap monitoring.
Purpose of the Study:
- To compare the efficacy of regional tissue oximetry (rSO₂) versus traditional clinical examination for monitoring lower limb free flaps.
- To evaluate the impact of rSO₂ monitoring on flap salvage rates and revision times.
Main Methods:
- A retrospective study comparing two groups of 148 lower limb free flaps.
- Group A utilized real-time rSO₂ monitoring (INVOS-TM 5100C).
- Group B relied on traditional clinical examination for flap monitoring.
Main Results:
- Overall flap survival showed a non-significant difference (94.6% vs. 90.5%).
- Flap salvage within 72 hours was faster in the rSO₂ group (121 min vs. 181 min, p<0.001).
- INVOS demonstrated 100% sensitivity and NPV, with 90% specificity.
Conclusions:
- Regional tissue oximetry is a reliable, non-invasive method for early detection of lower limb free flap complications.
- rSO₂ monitoring significantly accelerates flap revision surgeries.
- This technique aids in differentiating vascular issues and identifying local/systemic problems.
