Flap Monitoring by Transcutaneous PO2 and PCO2: Importance of Transcutaneous PCO2 in Determining Follow-up Treatment for Compromised Free Flaps

Ichiro Hashimoto; Hideki Nakanishi; Hirotsugu Takiwaki; Maki Toda Takase; Masahiro Yamano; Hiromichi Sedo

doi:10.1055/s-2007-985208

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2007; 23(5): 269-274
DOI: 10.1055/s-2007-985208

Flap Monitoring by Transcutaneous PO₂ and PCO₂: Importance of Transcutaneous PCO₂ in Determining Follow-up Treatment for Compromised Free Flaps

Ichiro Hashimoto¹ , Hideki Nakanishi¹ , Hirotsugu Takiwaki² , Maki Toda Takase¹ , Masahiro Yamano¹ , Hiromichi Sedo¹

¹Department of Plastic and Reconstructive Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
²Department of Dermatological Science, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan

Abstract

ABSTRACT

The authors conducted a two-part study to determine whether transcutaneous oxygen pressure (TcPO₂) and transcutaneous carbon dioxide pressure (TcPCO₂) can be used to monitor flap viability after transplantation. The first part was an animal study in which TcPO₂ and TcPCO₂ were measured in 10 epigastric island flaps subjected to arterial or venous ischemia. The second part was a clinical study in which both were measured in 27 free skin flaps. In the experimental study, TcPO₂ decreased to nearly 0 mmHg after 10 minutes of arterial and venous ischemia. TcPCO₂ increased to 100 mmHg after 60 minutes of either type of ischemia. In the clinical study, congestion was suspected in six flaps on the basis of clinical signs alone. Three congested flaps with TcPCO₂ more than 90 mmHg were selected for intervention. The remaining three congested flaps, with TcPCO₂ 80 mmHg or less, survived completely without further treatment. The TcPO₂ of all treated flaps and of the six flaps not requiring further treatment was 0 mmHg. Results of experimental study indicate that TcPO₂ is more sensitive than TcPCO₂ to flap ischemia. However, results of clinical study suggest that it is very hard to distinguish congested flaps from healthy flaps by TcPO₂ alone. The authors believe that a congested flap with a TcPCO₂ more than 90 mmHg requires further treatment.

KEYWORDS

Free flap monitoring - TcPO₂ and TcPCO₂ measurement - flap necrosis

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References

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Ichiro HashimotoM.D.

Department of Plastic and Reconstructive Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School

Kuramoto-cho, Tokushima 770-8503, Japan