Progress of monitoring methods and preventions of disorder of blood supplying of expanded flaps_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Yanxian ,  SONG Weiming

Department of Cervicofacial Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100144, P.R.China;

Corresponding?author：

SONG Weiming, Email: songweimingzx@163.com

Keywords：

Expanded flap; flap transplantation; disorder of blood supplying; monitoring method of blood supply

DOI：

10.7507/1002-1892.201708056

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the monitoring methods and preventions of the disorder of blood supplying of expanded flaps, so as to provide some references for improving the survival of expanded flaps. Methods The domestic and abroad related literature about the disorder of blood supplying of expanded flaps was reviewed and analyzed. Results Handheld Doppler, digital subtraction angiography, computer tomographic angiography, magnetic resonance angiography, and fluorescein angiography can be used as reliable preoperative imaging methods in designing expanded flaps with rich blood supply. Several techniques can be used for monitoring the blood supply of expanded flaps during the early postoperative period including traditional monitoring via physical examination, monitoring via dynamic infrared thermography, near-infrared spectroscopy tissue oximeter, external and implantable Doppler, and more recently developed diffuse correlation spectroscopy. Surgical delay, bloodletting, leech therapy, hyperbaric oxygen, and so on can decrease the risk of necrosis in expanded flaps. Conclusion The survival of expanded flap is influenced by many factors. Preoperative design by using handheld Doppler and new imaging technology and postoperative early detection of blood supply can provide references of timely intervention, so that ischemic necrosis of the flaps can be reduced, and the success rate of surgery can be improved.

Citation： LIN Yanxian, SONG Weiming. Progress of monitoring methods and preventions of disorder of blood supplying of expanded flaps. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 118-124. doi: 10.7507/1002-1892.201708056 Copy

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2.	Khatri N, Zhang S, Kale SS. Current techniques for postoperative monitoring of microvascular free flaps. J Wound Ostomy Continence Nurs, 2017, 44(2): 148-152.
3.	Sagaidachnyi AA, Fomin AV, Usanov DA, et al. Thermography-based blood flow imaging in human skin of the hands and feet: a spectral filtering approach. Physiol Meas, 2017, 38(2): 272-288.
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5.	Just M, Chalopin C, Unger M, et al. Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences. Eur Arch Otorhinolaryngol, 2016, 273(9): 2659-2667.
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7.	Akita S, Mitsukawa N, Tokumoto H, et al. Regional oxygen saturation index: A novel criterion for free flap assessment using tissue oximetry. Plast Reconstr Surg, 2016, 138(3): 510e-518e.
8.	Chen Y, Shen Z, Shao Z, et al. Free flap monitoring using near-infrared spectroscopy: A systemic review. Ann Plast Surg, 2016, 76(5): 590-597.
9.	Koolen PL, Vargas CR, Ho OA, et al. Does increased experience with tissue oximetry monitoring in microsurgical breast reconstruction lead to decreased flap loss? The learning effect. Plast Reconstr Surg, 2016, 137(4): 1093-1101.
10.	R?jdmark J, Blomqvist L, Malm M, et al. Metabolism in myocutaneous flaps studied by in situ microdialysis. Scand J Plast Reconstr Surg Hand Surg, 1998, 32(1): 27-34.
11.	Frost MW, Niumsawatt V, Rozen WM, et al. Direct comparison of postoperative monitoring of free flaps with microdialysis, implantable cook-swartz Doppler probe, and clinical monitoring in 20 consecutive patients. Microsurgery, 2015, 35(4): 262-271.
12.	Tollan CJ, MacFarlane N, MacKay IR. Microdialysis as a method of investigating factors controlling microcirculation following free flap transfer. Plast Reconstr Surg, 2015, 136(4 Suppl): 70-71.
13.	Ioannidis S, Spyropoulou GA, Sadigh P, et al. Pedicled free-style perforator flaps for trunk reconstruction: a reliable method. Plast Reconstr Surg, 2015, 135(2): 602-609.
14.	Bellamy JL, Mundinger GS, Flores JM, et al. Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region. Plast Reconstr Surg, 2015, 135(3): 883-892.
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19.	Rothenberger J, Amr A, Schaller HE, et al. Evaluation of a non-invasive monitoring method for free flap breast reconstruction using laser doppler flowmetrie and tissue spectrophotometry. Microsurgery, 2013, 33(5): 350-357.
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26.	Nagata T, Masumoto K, Uchiyama Y, et al. Improved technique for evaluating oral free flaps by pinprick testing assisted by indocyanine green near-infrared fluorescence angiography. J Craniomaxillofac Surg, 2014, 42(7): 1112-1116.
27.	Suchyta M, Mardini S. Innovations and future directions in head and neck microsurgical reconstruction. Clin Plast Surg, 2017, 44(2): 325-344.
28.	Ludolph I, Arkudas A, Schmitz M, et al. Cracking the perfusion code?: Laser-assisted Indocyanine Green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2016, 69(10): 1382-1388.
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43.	常謹, 劉國林, 劉碩, 等. VEGF 在不同皮膚擴張方式中表達的意義. 中國美容醫學, 2012, 21(13): 1770-1773.
44.	Hu X, Zeng G, Zhou Y, et al. Reconstruction of skin defects on the mid and lower face using expanded flap in the neck. J Craniofac Surg, 2017, 28(2): e137-e141.
45.	Omranifard M, Heidari M, Farajzadegan Z. The volume of fluid injected into the tissue expander and the tissue expansion. J Res Med Sci, 2014, 19(12): 1163-1166.
46.	Zhu H, Xie Y, Xie F, et al. Prevention of necrosis of adjacent expanded flaps by surgical delay. Ann Plast Surg, 2014, 73(5): 525-530.
47.	Hamilton K, Wolfswinkel EM, Weathers WM, et al. The delay phenomenon: a compilation of knowledge across specialties. Craniomaxillofac Trauma Reconstr, 2014, 7(2): 112-118.
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49.	Liu L, Zhang C, Tong H, et al. Silk Ligation Delay for the Random Pattern Flap. J Craniofac Surg, 2017, 28(1): 104-107.
50.	趙宇輝, 李莉, 王陽. 蒂部維持擴張法對遠位擴張皮瓣血運影響的臨床觀察. 中華創傷雜志, 2014, 30(8): 795-797.
51.	薛文麗, 宋維銘, 王佳琦, 等. 擴張皮瓣轉移術后血運障礙的原因分析與處理. 中國美容整形外科雜志, 2013, 24(5): 300-302.
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1. 王煒. 整形外科學. 杭州: 浙江科學技術出版社, 1999: 245-249.
2. Khatri N, Zhang S, Kale SS. Current techniques for postoperative monitoring of microvascular free flaps. J Wound Ostomy Continence Nurs, 2017, 44(2): 148-152.
3. Sagaidachnyi AA, Fomin AV, Usanov DA, et al. Thermography-based blood flow imaging in human skin of the hands and feet: a spectral filtering approach. Physiol Meas, 2017, 38(2): 272-288.
4. Hardwicke JT, Osmani O, Skillman JM. Detection of perforators using smartphone thermal imaging. Plast Reconstr Surg, 2016, 137(1): 39-41.
5. Just M, Chalopin C, Unger M, et al. Monitoring of microvascular free flaps following oropharyngeal reconstruction using infrared thermography: first clinical experiences. Eur Arch Otorhinolaryngol, 2016, 273(9): 2659-2667.
6. Lohman RF, Ozturk CN, Ozturk C, et al. An analysis of current techniques used for intraoperative flap evaluation. Ann Plast Surg, 2015, 75(6): 679-685.
7. Akita S, Mitsukawa N, Tokumoto H, et al. Regional oxygen saturation index: A novel criterion for free flap assessment using tissue oximetry. Plast Reconstr Surg, 2016, 138(3): 510e-518e.
8. Chen Y, Shen Z, Shao Z, et al. Free flap monitoring using near-infrared spectroscopy: A systemic review. Ann Plast Surg, 2016, 76(5): 590-597.
9. Koolen PL, Vargas CR, Ho OA, et al. Does increased experience with tissue oximetry monitoring in microsurgical breast reconstruction lead to decreased flap loss? The learning effect. Plast Reconstr Surg, 2016, 137(4): 1093-1101.
10. R?jdmark J, Blomqvist L, Malm M, et al. Metabolism in myocutaneous flaps studied by in situ microdialysis. Scand J Plast Reconstr Surg Hand Surg, 1998, 32(1): 27-34.
11. Frost MW, Niumsawatt V, Rozen WM, et al. Direct comparison of postoperative monitoring of free flaps with microdialysis, implantable cook-swartz Doppler probe, and clinical monitoring in 20 consecutive patients. Microsurgery, 2015, 35(4): 262-271.
12. Tollan CJ, MacFarlane N, MacKay IR. Microdialysis as a method of investigating factors controlling microcirculation following free flap transfer. Plast Reconstr Surg, 2015, 136(4 Suppl): 70-71.
13. Ioannidis S, Spyropoulou GA, Sadigh P, et al. Pedicled free-style perforator flaps for trunk reconstruction: a reliable method. Plast Reconstr Surg, 2015, 135(2): 602-609.
14. Bellamy JL, Mundinger GS, Flores JM, et al. Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region. Plast Reconstr Surg, 2015, 135(3): 883-892.
15. Nanno M, Kodera N, Tomori Y, et al. Color Doppler ultrasound assessment for identifying perforator arteries of the second dorsal metacarpal flap. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499016684744.
16. Kim JT, Ho SY, Kim YH. A chimaeric-pattern flap design for implantable Doppler surrogate monitoring: a novel placement technique. J Plast Reconstr Aesthet Surg, 2014, 67(2): 190-197.
17. Chang EI, Ibrahim A, Zhang H, et al. Deciphering the Sensitivity and Specificity of the Implantable Doppler Probe in Free Flap Monitoring. Plast Reconstr Surg, 2016, 137(3): 971-976.
18. Rothfuss MA, Unadkat JV, Gimbel ML, et al. Totally Implantable Wireless Ultrasonic Doppler Blood Flowmeters: Toward Accurate Miniaturized Chronic Monitors. Ultrasound Med Biol, 2017, 43(3): 561-578.
19. Rothenberger J, Amr A, Schaller HE, et al. Evaluation of a non-invasive monitoring method for free flap breast reconstruction using laser doppler flowmetrie and tissue spectrophotometry. Microsurgery, 2013, 33(5): 350-357.
20. Kolbenschlag J, Sogorski A, Kapalschinski N, et al. Remote Ischemic Conditioning Improves Blood Flow and Oxygen Saturation in Pedicled and Free Surgical Flaps. Plast Reconstr Surg, 2016, 138(5): 1089-1097.
21. Holm C, Dornseifer U, Sturtz G, et al. Sensitivity and specificity of ICG angiography in free flap reexploration. J Reconstr Microsurg, 2010, 26(5): 311-316.
22. Lohman RF, Ozturk CN, Ozturk C, et al. An analysis of current techniques used for intraoperative flap evaluation. Ann Plast Surg, 2015, 75(6): 679-685.
23. Diep GK, Hui JY, Marmor S, et al. Postmastectomy reconstruction outcomes after intraoperative evaluation with indocyanine green angiography versus clinical assessment. Ann Surg Oncol, 2016, 23(12): 4080-4085.
24. Hitier M, Cracowski JL, Hamou C, et al. Indocyanine green fluorescence angiography for free flap monitoring: A pilot study. J Craniomaxillofac Surg, 2016, 44(11): 1833-1841.
25. Lohman RF, Ozturk CN, Ozturk C, et al. An analysis of current techniques used for intraoperative flap evaluation. Ann Plast Surg, 2015, 75(6): 679-685.
26. Nagata T, Masumoto K, Uchiyama Y, et al. Improved technique for evaluating oral free flaps by pinprick testing assisted by indocyanine green near-infrared fluorescence angiography. J Craniomaxillofac Surg, 2014, 42(7): 1112-1116.
27. Suchyta M, Mardini S. Innovations and future directions in head and neck microsurgical reconstruction. Clin Plast Surg, 2017, 44(2): 325-344.
28. Ludolph I, Arkudas A, Schmitz M, et al. Cracking the perfusion code?: Laser-assisted Indocyanine Green angiography and combined laser Doppler spectrophotometry for intraoperative evaluation of tissue perfusion in autologous breast reconstruction with DIEP or ms-TRAM flaps. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2016, 69(10): 1382-1388.
29. Mcke T, Fichter AM, Schmidt LH, et al. Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using the flow? 800 tool. Microsurgery, 2017, 37(3): 235-242.
30. 張子陽, 張文奪, 魏在榮, 等. 數字減影血管造影在脛后動脈穿支皮瓣修復足踝部創面中的應用研究. 中國修復重建外雜志, 2015, 29(9): 1109-1112.
31. 唐舉玉, 卿黎明, 賀繼強, 等. 數字化技術輔助旋股外側動脈降支分葉穿支皮瓣設計的初步應用. 中華顯微外科雜志, 2016, 39(2): 123-126.
32. 張子陽, 魏在榮, 張文奪, 等. 數字減影血管造影術前導航指導切取脛前動脈穿支皮瓣修復足踝部創面 13 例. 中華燒傷雜志, 2016, 32(10): 620-622.
33. 徐業凱, 袁斯明, 郭遙, 等. 應用數字減影血管造影術指導皮瓣選擇修復嚴重手外傷創面. 組織工程與重建外科雜志, 2016, 12(6): 357-359.
34. Mohan AT, Saint-Cyr M. Advances in imaging technologies for planning breast reconstruction. Gland Surg, 2016, 5(2): 242-254.
35. 楊克勤, 莫勇軍, 譚海濤, 等. CTA 技術在小腿穿支皮瓣修復踝周組織缺損中的應用. 中華顯微外科雜志, 2017, 40(2): 168-171.
36. Maricevich MA, Bykowski MR, Schusterman MA 2nd, et al. Lateral thigh perforator flap for breast reconstruction: Computed tomographic angiography analysis and clinical series. J Plast Reconstr Aesthet Surg, 2017, 70(5): 577-584.
37. Hummelink S, Verhulst AC, Maal TJJ, et al. An innovative method of planning and displaying flap volume in DIEP flap breast reconstructions. J Plast Reconstr Aesthet Surg, 2017, 70(7): 871-875.
38. Ono S, Hayashi H, Ohi H, et al. Imaging studies for preoperative planning of perforator flaps: An overview. Clin Plast Surg, 2017, 44(1): 21-30.
39. 段家章, 何曉清, 徐永清. 股前外側皮瓣血管解剖學及術前皮瓣設計技術研究進展. 中國修復重建外科雜志, 2016, 30(7): 909-914.
40. Gryseleyn R, Schlund M, Pigache P, et al. Influence of preoperative imaging on fibula free flap harvesting. J Stomatol Oral Maxillofac Surg, 2017, 118(5): 265-270.
41. Swanson EW, Hsu YC, Cheng HT. CTA and contrast-enhanced MRA are equally accurate for localizing deep inferior epigastric perforator flap arteries: a systematic review. J Plast Reconstr Aesthet Surg, 2015, 68(4): 580-581.
42. Agochukwu NB, Huang C, Zhao M, et al. A novel noncontact diffuse correlation spectroscopy device for assessing blood flow in mastectomy skin flaps: A prospective study in patients undergoing prosthesis-based reconstruction. Plast Reconstr Surg, 2017, 140(1): 26-31.
43. 常謹, 劉國林, 劉碩, 等. VEGF 在不同皮膚擴張方式中表達的意義. 中國美容醫學, 2012, 21(13): 1770-1773.
44. Hu X, Zeng G, Zhou Y, et al. Reconstruction of skin defects on the mid and lower face using expanded flap in the neck. J Craniofac Surg, 2017, 28(2): e137-e141.
45. Omranifard M, Heidari M, Farajzadegan Z. The volume of fluid injected into the tissue expander and the tissue expansion. J Res Med Sci, 2014, 19(12): 1163-1166.
46. Zhu H, Xie Y, Xie F, et al. Prevention of necrosis of adjacent expanded flaps by surgical delay. Ann Plast Surg, 2014, 73(5): 525-530.
47. Hamilton K, Wolfswinkel EM, Weathers WM, et al. The delay phenomenon: a compilation of knowledge across specialties. Craniomaxillofac Trauma Reconstr, 2014, 7(2): 112-118.
48. 姚媛媛, 張金明, 梁偉強, 等. 埋線法結扎周邊血管預防擴張皮瓣靜脈淤血的療效觀察. 中國修復重建外科雜志, 2015, 29(6): 789-791.
49. Liu L, Zhang C, Tong H, et al. Silk Ligation Delay for the Random Pattern Flap. J Craniofac Surg, 2017, 28(1): 104-107.
50. 趙宇輝, 李莉, 王陽. 蒂部維持擴張法對遠位擴張皮瓣血運影響的臨床觀察. 中華創傷雜志, 2014, 30(8): 795-797.
51. 薛文麗, 宋維銘, 王佳琦, 等. 擴張皮瓣轉移術后血運障礙的原因分析與處理. 中國美容整形外科雜志, 2013, 24(5): 300-302.
52. Cheng Z, Wu W, Hu P, et al. Distally based saphenous nerve-greater saphenous venofasciocutaneous flap for reconstruction of soft tissue defects in distal lower leg. Ann Plast Surg, 2016, 77(1): 102-105.
53. Herlin C, Bertheuil N, Bekara F, et al. Leech therapy in flap salvage: Systematic review and practical recommendations. Ann Chir Plast Esthet, 2017, 62(2): e1-e13.
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Chinese Journal of Reparative and Reconstructive Surgery

Progress of monitoring methods and preventions of disorder of blood supplying of expanded flaps

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