Advanced Microcirculatory Parameters of Lower Extremity Free Flaps during Dangling and Their Influencing Factors

Jonas Kolbenschlag; Pascal Bredenbroeker; Marcus Lehnhardt; Adrien Daigeler; Sebastian Fischer; Kamran Harati; Andrej Ring; Ole Goertz

doi:10.1055/s-0035-1554940

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2015; 31(07): 500-507
DOI: 10.1055/s-0035-1554940

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Advanced Microcirculatory Parameters of Lower Extremity Free Flaps during Dangling and Their Influencing Factors

Jonas Kolbenschlag

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

,

Pascal Bredenbroeker

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

,

Marcus Lehnhardt

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

,

Adrien Daigeler

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

,

Sebastian Fischer

²Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany

,

Kamran Harati

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

,

Andrej Ring

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

,

Ole Goertz

¹Department of Plastic Surgery, Burn Center, Sarcoma Center, BG University Hospital, Ruhr University, Bochum, Germany

› Author Affiliations

Abstract

Background Dangling of the leg to habituate a free flap to the lower extremity is common practice. However, little is known about the microcirculatory changes in free flaps and the influence of comorbidities.

Methods Tissue oxygen saturation (StO₂) and hemoglobin content (tissue hemoglobin index [THI]) of 39 lower extremity free flaps was measured during dangling on postoperative days (PODs) 6 to 9. We assessed the maximal desaturation during dangling and re-elevation and the maximal increase in THI as well as the time required to reach a stable plateau during dangling, among others.

Results All parameters showed significant changes during dangling (desaturation during dangling: 0.23 ± 10.7 vs. − 4.66 ± 12.6%, p = 0.001 for POD 6 vs. 7; further desaturation after re-elevation: − 11.1 ± 7.4 versus − 14.5 ± 7.8%, p = 0.001 for POD 6 vs. 9; THI increase during dangling: from 3.4 ± 1.6 to 4.2 ± 1.8 AU, p = 0.008, time to THI plateau: 1.7 ± 1.2 vs. 2.5 ± 1.7 minutes, p = 0.004 for POD 6 vs. 7). Age, gender, and smoking did not influence the mentioned parameters. Nondiabetic patients showed a significant increase of baseline StO₂, whereas diabetic patients did not (p = 0.009 vs. 0.11). For THI, both diabetic and hypertensive patients showed a lower increase in THI on the first day of dangling (p = 0.056; p = 0.009) and significantly lower baseline values on the last day (0.046 for both).

Conclusion Duration of dependency seems to have the greatest impact on microcirculation during dangling, although comorbidities may interfere with the adaptive processes. An earlier start of dangling could safely be applied in most patients. Special care needs to be taken in diabetic and hypertensive patients.

Keywords

free flap - dangling - lower extremity - reconstruction - microcirculation

Full Text

References

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