The differentiation of arterial versus venous occlusion in free tissue transfers has rarely been described. This study investigated changes in blood flow caused by arterial and venous occlusion and the potential for laser Doppler flowmetry to distinguish between these 2 conditions for better clinical assessment and management of free tissue transfer.
Methods:
Six patients with a mean age of 43.5 years underwent microsurgical free tissue transfer. The venous and arterial blood flow of the vessels and skin flap were monitored using laser Doppler flowmetry with high-frequency pulsed Doppler transducers for vessels and skin before, during, and after clamping the vessels for 10 minutes.
Results:
The average decreases in blood flow in the artery and vein caused by clamping were 94.4% and 93.8%, respectively. On average, arterial occlusion demonstrated a sudden drop of 67.7% and venous occlusion caused a decrease of 26.6% on laser Doppler flowmetry in free tissue skin.
Conclusion:
Using a vessel-holding probe, laser Doppler flowmetry could be used to differentiate between arterial and venous occlusion in free tissue transfer, thereby aiding decision-making for better clinical management.
WeiFCJainVCelikNChenHCChuangDCLinCH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109(7):2219–2226. discussion 2227-2230.
3.
HanasonoMMWeinstockYEYuP. Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 2008;122(6):1739–1746.
4.
BuiDTCordeiroPGHuQYDisaJJPusicAMehraraBJ. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119(7):2092–2100.
5.
JonesNFJarrahyRSongJIKaufmanMRMarkowitzB. Postoperative medical complications—not microsurgical complications—negatively influence the morbidity, mortality, and true costs after microsurgical reconstruction for head and neck cancer. Plast Reconstr Surg. 2007;119(7):2053–2060.
6.
ChenKTMardiniSChuangDC, et al.Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg. 2007;120(1):187–195.
7.
LuuQFarwellDG. Advances in free flap monitoring: have we gone too far?Curr Opin Otolaryngol Head Neck Surg. 2009;17(4):267–269.
8.
SmitJMZeebregtsCJAcostaRWerkerPM. Advancements in free flap monitoring in the last decade: a critical review. Plast Reconstr Surg. 2010;125(1):177–185.
9.
SilvermanDGLaRossaDDBarlowCHBeringTGPopkyLMSmithTC. Quantification of tissue fluorescein delivery and prediction of flap viability with the fiberoptic dermofluorometer. Plast Reconstr Surg. 1980;66(4):545–553.
10.
JonesNFKuzonWMJrShestakKCRothAG. Use of fluorescein to predict survival of a free jejunal transfer after disruption of the arterial pedicle on postoperative day 12. Br J Plast Surg. 1994;47(5):375–377.
11.
FutranNDStackBCJrHollenbeakCScharfJE. Green light photoplethysmography monitoring of free flaps. Arch Otolaryngol Head Neck Surg. 2000;126(5):659–662.
12.
ChubbDRozenWMAshtonMW. Early survival of a compromised fasciocutaneous flap without pedicle revision: monitoring with photoplethysmography. Microsurgery2010;30(6):462–465.
13.
HölzleFRauALoeffelbeinDJMückeTKestingMRWolffKD. Results of monitoring fasciocutaneous, myocutaneous, osteocutaneous and perforator flaps: 4-year experience with 166 cases. Int J Oral Maxillofac Surg. 2010;39(1):21–28.
14.
MahoneyJLListaFR. Variations in flap blood flow and tissue PO2: a new technique for monitoring flap viability. Ann Plast Surg. 1988;20(1):43–47.
15.
KhouriRKShawWW. Monitoring of free flaps with surface-temperature recordings: is it reliable?Plast Reconstr Surg. 1992;89(3):495–499. discussion 500-492.
16.
KraemerRLorenzenJKnoblochK, et al.Free flap microcirculatory monitoring correlates to free flap temperature assessment. J Plast Reconstr Aesthet Surg. 2011;64(10):1353–1358.
17.
HallockGG. Acoustic Doppler sonography, color duplex ultrasound, and laser Doppler flowmetry as tools for successful autologous breast reconstruction. Clin Plast Surg. 2011;38(2):203–211.
18.
HellerLLevinLSKlitzmanB. Laser Doppler flowmeter monitoring of free-tissue transfers: blood flow in normal and complicated cases. Plast Reconstr Surg. 2001;107(7):1739–1745.
19.
YuenJCFengZ. Monitoring free flaps using the laser Doppler flowmeter: five-year experience. Plast Reconstr Surg. 2000;105(1):55–61.
20.
GallaTJHellekesDFellerAM. Differentiation between arterial and venous vessel occlusion by simultaneous measurement with laser Doppler flowmetry and photoplethysmography. J Reconstr Microsurg. 1999;15(1):67–72.
21.
CornejoARodriguezTSteigelmanM, et al.The use of visible light spectroscopy to measure tissue oxygenation in free flap reconstruction. J Reconstr Microsurg. 2011;27(7):397–402.
22.
KellerA. A new diagnostic algorithm for early prediction of vascular compromise in 208 microsurgical flaps using tissue oxygen saturation measurements. Ann Plast Surg. 2009;62(5):538–543.
23.
LinSJNguyenMDChenC, et al.Tissue oximetry monitoring in microsurgical breast reconstruction decreases flap loss and improves rate of flap salvage. Plast Reconstr Surg. 2011;127(3):1080–1085.
24.
HolzleFLoeffelbeinDJNolteDWolffKD.Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J Craniomaxillofac Surg. 2006;34(1):25–33.
25.
CummingsCWTrachyRERichardsonMAPattersonHC. Prognostication of myocutaneous flap viability using laser Doppler velocimetry and fluorescein microfluorometry. Otolaryngol Head Neck Surg. 1984;92(5):559–563.
26.
SvenssonHSvedmanPHolmbergJWieslanderJB. Detecting changes of arterial and venous blood flow in flaps. Ann Plast Surg. 1985;15(1):35–40.
27.
KrollSSSchustermanMAReeceGP, et al.Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg. 1996;98(7):1230–1233.
28.
Abdel-GalilKMitchellD. Postoperative monitoring of microsurgical free-tissue transfers for head and neck reconstruction: a systematic review of current techniques—part II. Invasive techniques. Br J Oral Maxillofac Surg. 2009;47(5):438–442.
29.
Abdel-GalilKMitchellD. Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques—part I. Non-invasive techniques. Br J Oral Maxillofac Surg. 2009;47(5):351–355.
30.
WalkinshawMHollowayABulkleyAEngravLH. Clinical evaluation of laser Doppler blood flow measurements in free flaps. Ann Plast Surg. 1987;18(3):212–217.
31.
FischerJCParkerPMShawWW. Comparison of two laser Doppler flowmeters for the monitoring of dermal blood flow. Microsurgery. 1983;4(3):164–170.
32.
FischerJCParkerPMShawWW. Laser Doppler flowmeter measurements of skin perfusion changes associated with arterial and venous compromise in the cutaneous island flap. Microsurgery. 1985;6(4):238–243.
33.
FischerJCParkerPMShawWW. Waveform analysis applied to laser Doppler flowmetry. Microsurgery. 1986;7(2):67–71.
34.
FernandoBYoungVLLoganSE. Miniature implantable laser Doppler probe monitoring of free tissue transfer. Ann Plast Surg. 1988;20(5):434–442.
35.
GoldbergJSepkaRSPeronaBPPedersonWCKlitzmanB.Laser Doppler blood flow measurements of common cutaneous donor sites for reconstructive surgery. Plast Reconstr Surg. 1990;85(4):581–586.
36.
SvenssonHHolmbergJSvedmanP. Interpreting laser Doppler recordings from free flaps. Scand J Plast Reconstr Surg Hand Surg. 1993;27(2):81–87.
37.
PlaceMJWittPHendricksD. Cutaneous blood-flow patterns in free flaps determined by laser Doppler flowmetry. J Reconstr Microsurg. 1996;12(6):355–358.
38.
HallockGG. A “True” false-negative misadventure in free flap monitoring using laser Doppler flowmetry. Plast Reconstr Surg. 2002;110(6):1609–1611.
39.
BoutaultFCadenatHHibertPJ. Evaluation of gingival microcirculation by a laser-Doppler flowmeter. Preliminary results. J Craniomaxillofac Surg. 1989;17(3):105–109.
40.
ClintonMSSepkaRSBristolD, et al.Establishment of normal ranges of laser Doppler blood flow in autologous tissue transplants. Plast Reconstr surg. 1991;87(2):299–309.
41.
HoviusSEvan AdrichemLNMulderHDvan StrikRvan der MeulenJC. The predictive value of the laser Doppler flowmeter for postoperative microvascular monitoring. Ann Plast Surg. 1993;31(4):307–312.
42.
YoshinoKNaraSEndoMKamataN. Intraoral free flap monitoring with a laser Doppler flowmeter. Microsurgery. 1996;17(6):337–340.
43.
GuillemaudJPSeikalyHCoteDAllenHHarrisJR. The implantable Cook-Swartz Doppler probe for postoperative monitoring in head and neck free flap reconstruction. Arch Otolaryngol Head Neck Surg. 2008;134(7):729–734.
44.
SmitJMWerkerPMLissAG, et al.Introduction of the implantable Doppler system did not lead to an increased salvage rate of compromised flaps: a multivariate analysis. Plast Reconstr Surg. 2010;125(6):1710–1717.
45.
MuckeTWolffKDRauAKehlVMitchellDASteinerT.Autonomization of free flaps in the oral cavity: a prospective clinical study. Microsurgery. 2012;32(3):201–206.
46.
RothenbergerJAmrASchallerHERahmanian-SchwarzA. 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.
47.
RitschlLMSchmidtLHFichterAMHapfelmeierAWolffKDMückeT. Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats. J Craniomaxillofac Surg. 2018;46(6):905–915.
