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CC BY-NC-ND 4.0 · Indian J Plast Surg 2023; 56(03): 260-266
DOI: 10.1055/s-0042-1759726
Original Article

Difference between Capillary Blood Glucose of Free Flap and the Patient: A Novel Objective Marker of Free Flap Vascular Compromise during Postoperative Monitoring

Sourabh Shankar Chakraborty 
1   Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
,
Ranjit Kumar Sahu 
2   Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Manojit Midya
3   Department of Plastic Surgery, Government Medical College, Kota, Rajasthan, India
,
Anjana Malhotra
1   Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
,
Akhil Dhanesh Goel 
4   Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Ashish Pundhir
5   Department of Community Medicine, All India Institute of Medical Sciences, Kalyani, Kolkata, West Bengal, India
,
Sudeshna Acharya 
6   Department of Trauma & Emergency, Burdwan Medical College, Bardhaman, West Bengal, India
› Author Affiliations Funding None.
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Abstract

Background Defining cut-off values of flap glucose levels in diagnosing free flap vascular compromise, without taking patients' glucose levels into account, does not hold good in all circumstances, especially in cases of high fluctuations in patients' capillary blood glucose and in diabetic patients. The aim of our study was to establish the role of capillary blood glucose measurements of the flap in relation to patients' fingertip, as an objective tool for postoperative free flap monitoring.

Methods A total of 76 free flaps underwent postoperative monitoring with reference test (clinical parameters) and simultaneously with our index test (difference between capillary blood glucose of free flap and the patient), in non-diabetic and diabetic patients. Patients' demography and flap characteristics were also recorded. An ROC curve was plotted to determine diagnostic accuracy and cut-offs of the index test in diagnosing free flap vascular compromise.

Results Our Index test has a cut-off value of 24.5 mg/dL with 68.75% sensitivity and 93% specificity, with an accuracy of 91.54%.

Conclusion The difference between capillary blood glucose of free flap and the patient is simple, feasible, and inexpensive, and can be done by any health care professional and does not require any specialized facilities or training. It has an excellent diagnostic accuracy to detect impending free flap vascular compromise, especially in non-diabetics. Although in diabetics, this test becomes less accurate. Being an observer-independent objective test, the difference in capillary blood glucose of patient and flap measurement can be used as a highly reliable tool for postoperative free flap monitoring.

Keywords

free flap - flap monitoring - capillary glucose measurement - objective monitoring


Publication History

Article published online:
22 December 2022

© 2022. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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