Smit JM, Negenborn VL, Jansen SM, Jaspers MEH, de Vries R, Heymans MW, Winters HAH, van Leeuwen TG, Mullender MG, Krekel NMA, et al.
Microsurgery. Date of publication 2018 Oct 1;volume 38(7):804-818.
1. Microsurgery. 2018 Oct;38(7):804-818. doi: 10.1002/micr.30320. Epub 2018 Mar 25.
Intraoperative evaluation of perfusion in free flap surgery: A systematic review
and meta-analysis.
Smit JM(1), Negenborn VL(1)(2), Jansen SM(3), Jaspers MEH(1)(4), de Vries R(5),
Heymans MW(6), Winters HAH(1), van Leeuwen TG(7), Mullender MG(1)(8), Krekel
NMA(1).
Author information:
(1)Department of Plastic, Reconstructive & Hand Surgery, VU University Medical
Centre, Amsterdam, The Netherlands.
(2)Amsterdam Public Health research institute, VU University Medical Center,
Amsterdam, The Netherlands.
(3)Department of Plastic, Reconstructive & Hand Surgery, Academical Medical
Center, Amsterdam, The Netherlands.
(4)Association of Dutch Burn Centers, Beverwijk, The Netherlands.
(5)Medical Library, Vrije Universiteit, Amsterdam, The Netherlands.
(6)Department of Epidemiology & Biostatistics, VU University Medical Centre,
Amsterdam, The Netherlands.
(7)Department of. Biomedical Engineering & Physics, Academical Medical Center,
Amsterdam, The Netherlands.
(8)Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The
Netherlands.
BACKGROUND: Free flap survival relies on adequate tissue perfusion. We aim to
give an overview of the available literature of all objective methods to
intraoperatively assess free flap tissue perfusion, and the effects on (partial)
flap loss.
METHODS: A systematic review and meta-analysis according to the PRISMA guidelines
was performed (PubMed, Cochrane Library, Embase) regarding English language
articles. Meta-analyses were performed by pooling means and slopes using
random-effect models.
RESULTS: Sixty-four articles were included reporting on 2369 procedures in 2009
patients with various indications. Reported methods were fluorescence imaging
(FI), laser Doppler, oxygen saturation, ultrasound, (dynamic) infrared
thermography, venous pressure, and microdialysis. Intraoperative tissue perfusion
was adequately measured by the use of FI and laser Doppler, leading to surgical
intervention or altered flap design, and increased flap survival. Meta-analysis
showed a mean time until onset of the dye to become visible of 18.4 (7.27; 29.46,
Q P < 0.001) sec. The relative intensity of the flap compared to the intensity
curve of normal tissue was 75.92% (65.85; 85.98, Q P = 0.719). The mean
difference in the slope value of the oxygen tensions before and after the
anastomosis was -0.09 (-0.12; -0;06 Q P = 0.982). No convincing evidence was
found for the use of other methods.
CONCLUSIONS: Based on the current literature, FI and laser Doppler are most
suitable to intraoperatively measure free flap tissue perfusion, resulting in
improved flap survival. However, this review was limited by the available
literature. Additional studies are necessary to investigate the predictive value
of intraoperative perfusion measurement.
© 2018 Wiley Periodicals, Inc.
DOI: 10.1002/micr.30320
PMID: 29577423 [Indexed for MEDLINE]
