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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2020; 05(02): e79-e81
DOI: 10.1055/s-0040-1717110
Letter to the Editor: Short Report

Evaluating the Effect of Leg Position and Negative Pressure Wound Therapy on Lower Extremity Oxygenation Measured by Noninvasive Tissue Oximetry: A Pilot Study

Claire Isabelle Verret
1   Hospital for Special Surgery, New York, New York
2   Weill Cornell Medical College, New York, New York
,
Meridith Pollie
1   Hospital for Special Surgery, New York, New York
2   Weill Cornell Medical College, New York, New York
,
Jona Kerluku
1   Hospital for Special Surgery, New York, New York
,
Sravan Dhulipala
1   Hospital for Special Surgery, New York, New York
,
Duretti Fufa
1   Hospital for Special Surgery, New York, New York
2   Weill Cornell Medical College, New York, New York
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Abstract

Background Flap loss is a catastrophic complication following lower extremity reconstructions. Close monitoring can detect circulatory changes, particularly when introducing gravity through dangle protocols. Noninvasive near-infrared spectroscopy (NIRS) tissue oximetry is one such method used for continuous monitoring of tissue perfusion. Recently, negative pressure wound therapy (NPWT) has been for compromised flaps salvage. We used NIRS to study the impact of leg positioning and NPWT on lower extremity perfusion during a mock dangle protocol.

Methods A tissue oximeter transcutaneous probe was placed on each lower limb of five normal patients at the location of the highest density of peroneal artery perforators along the distal one-third fibula. The experimental leg probe was covered with NPWT at 100 mm Hg. The contralateral leg served as control. Tissue oxygen saturation (StO2) was measured continuously for 140 minutes. Leg position was changed in every 20 minutes to mimic a dangle protocol.

Results Our results showed higher StO2 with leg elevation, and lower StO2 in dependent positions in the control limb. StO2 was consistently higher in the limb with NPWT, which had a slower rate of deoxygenation with introduction of gravity. In both conditions, on returning to neutral position from the dependent, StO2 returned to levels close to baseline.

Conclusion These data provide further information on hemodynamic changes introduced by gravity, and how NPWT might modulate these changes.

Keywords

negative pressure wound therapy - noninvasive tissue oximetry - lower extremity oxygenation


Publication History

Received: 03 May 2020

Accepted: 15 August 2020

Article published online:
01 October 2020

© .

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

 

  • References

  • 1 Kolbenschlag J, Ruikis A, Faulhaber L. et al. Elastic wrapping of lower extremity free flaps during dangling improves microcirculation and reduces pain as well as edema. J Reconstr Microsurg 2019; 35 (07) 522-528
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Keller A. Noninvasive tissue oximetry. Clin Plast Surg 2011; 38 (02) 313-324
    CrossrefPubMedSearch in Google Scholar
  • 3 Bi H, Khan M, Li J, Pestana IA. Use of incisional negative pressure wound therapy in skin-containing free tissue transfer. J Reconstr Microsurg 2018; 34 (03) 200-205
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Kolbenschlag J, Bredenbroeker P, Daigeler A. et al. Changes of oxygenation and hemoglobin-concentration in lower extremity free flaps during dangling. J Reconstr Microsurg 2014; 30 (05) 319-328
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Sogorski A, Lehnhardt M, Goertz O. et al. Improvement of local microcirculation through intermittent negative pressure wound therapy (NPWT). J Tissue Viability 2018; 27 (04) 267-273
    CrossrefPubMedSearch in Google Scholar