Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Decreases Flap Loss and Improves Rate of Flap Salvage
Samuel J. Lin, MD, Minh-Doan Nguyen, MD PhD, Chen Chen, MD, Salih Colakoglu, MD, Michael S. Curtis, MD, Adam M. Tobias, MD, Bernard T. Lee, MD.
Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA.
Since the inception of microvascular free tissue transfer, flap monitoring has been based on clinical signs. Color, capillary refill, and handheld Doppler have been used for monitoring in the post-operative period; however, subjective clinical examination may delay recognition of flap compromise. Tissue oximeter (ViOptix, Fremont CA) monitoring offers an objective method for detecting vascular compromise with the measurement of tissue oxygen saturation and real-time flap perfusion.
We reviewed 614 consecutive microsurgical flaps for breast reconstruction from 2004 to 2010. Our first 380 patients underwent clinical flap post-operative monitoring. Starting in June 2008, we used tissue oximetry as an adjunct on 234 consecutive patients. Flap re-exploration, flap loss, salvage rate, fat necrosis, and characteristics of vascular compromise were analyzed.
There were 26 (6.8%) instances of flap re-exploration and 11 (2.9%) flap losses prior to use of tissue oximetry. After tissue oximetry was used, there were 16 (6.8%) instances of flap re-exploration and 1 flap loss. The rate of flap re-exploration was not statistically significant between groups, but the difference between the flap failure rates is significant (p = 0.025). The flap salvage rate was previously 57.7%, but after tissue oximetry monitoring was 93.75% (p = 0.015).
The use of tissue oximetry has decreased our flap loss rate and improved the flap salvage rate in microsurgical breast reconstruction. This device is a useful adjunct in flap monitoring during the post-operative period as it may help decrease flap loss by detecting impending vascular compromise before it becomes clinically evident.
Table 1: Flap Complications
|Return to OR (Breast)||26 (6.8%)||16 (6.8%)||p = 0.998^|
|Total flap loss||11 (2.9%)||1 (0.43%)||p =0.025*|
|Flap salvage rate||15/26 (57.7%)||15/16 (93.75%)||p = 0.015*|
|Partial flap loss||8 (2.1%)||4 (1.7%)||p = 0.395*|
|Fat necrosis||62 (16.3%)||33 (14.1%)||p = 0.461^|
*Fisher’s exact test
^Chi square test
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