Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements : experimental study
Résumé
Introduction: In surgery, some defects require reconstruction with microsurgical flap. The free flap failure rate varies between 2% and 5% with severe. Vascular thrombosis is the most frequent complication and represents 15-73%. The success rate of salvage therapy is greater when salvage surgery is early. Currently clinical monitoring is the gold standard. Many non-invasive or minimally invasive techniques have been developed to improve early diagnosis of complications of vascular thrombosis. Each technique has advantages and disadvantages. The aim of our experimental study was to compare the clinical assessment and intracapillary glycemia and lactataemia measurements during monitoring of free flaps. Material and methods: Pigs (Sus scrofa domesticus) were operated under general anesthesia. A myocutaneous latissimus dorsi with skin paddle was performed. Each animal was operated twice (right and left) similarly. 4 groups were made: Group 1 (no flap ligature or control group); Group 2 (flap with final ligation of the artery); Group 3 (flap with final ligation of the two veins); Group 4 (flap with transient ligature of the artery and two veins for 1 hour). An incision was made in the center of the skin paddle to make the measurements. Postoperative monitoring protocol consisted of a triple monitoring: clinical, biological and histological. Results: Eight animals were operated and sixteen flaps were realized. Each flap was clinically and biologically tested 25 times. Clinical, biological and histological monitoring showed significant variations according to the groups. Discussion-Conclusion: Experimentally the intra-capillary measures of lactate and glucose levels associated with clinical monitoring may shorten the delay in diagnosis. Ultimately this will save lives and achieve better functional and aesthetic results.