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Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction

Although free tissue transplantation (FTT) is an essential technique in extremity functional reconstruction, postoperative blood flow disturbance is one of the critical complications leading to transplanted tissue necrosis. Early detection of this complication may prevent tissue failure by prompt im...

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Autores principales: Nakano, Takahiko, Kudo, Toshiya, Sano, Yoshitomo, Minehara, Hiroaki, Suzuki, Masao, Aoki, Kohei, Matsushita, Takashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390811/
https://www.ncbi.nlm.nih.gov/pubmed/35999883
http://dx.doi.org/10.1097/GOX.0000000000004467
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author Nakano, Takahiko
Kudo, Toshiya
Sano, Yoshitomo
Minehara, Hiroaki
Suzuki, Masao
Aoki, Kohei
Matsushita, Takashi
author_facet Nakano, Takahiko
Kudo, Toshiya
Sano, Yoshitomo
Minehara, Hiroaki
Suzuki, Masao
Aoki, Kohei
Matsushita, Takashi
author_sort Nakano, Takahiko
collection PubMed
description Although free tissue transplantation (FTT) is an essential technique in extremity functional reconstruction, postoperative blood flow disturbance is one of the critical complications leading to transplanted tissue necrosis. Early detection of this complication may prevent tissue failure by prompt improvement of blood flow. The aim of this study was to determine whether transcutaneous carbon dioxide pressure (TcPCO(2)) monitoring increases the salvage rates after FTT. METHODS: We retrospectively reviewed 75 consecutive patients who underwent FTT for extremity reconstruction with TcPCO(2) monitoring postoperatively between December 2016 and September 2021. RESULTS: Extremity reconstruction was performed in 53 cases due to trauma, 20 cases due to infection, and two cases due to tumor resection for tissue defects. The overall success rate of the FTT was 98.7%, with 13 complications. Of the 11 patients who underwent reoperation, nine had thrombosis and two had vascular strangulation. However, when reoperation was decided, none of the reoperation cases still exhibited any deterioration in the Doppler or clinical assessment. All reoperated cases were salvaged. Of the two patients who did not undergo reoperation, one had failed flaps and one had partial skin necrosis. With a TcPCO(2) cutoff value of 70 mm Hg, the sensitivity and specificity for detecting complications due to impaired blood flow were 100% and 93.5%, respectively. CONCLUSIONS: TcPCO(2) monitoring was performed after FTT for extremity reconstruction, and all cases of reoperation were salvaged. TcPCO(2) monitoring can detect impaired postoperative blood flow critically earlier than clinical assessments and may increase salvage rates of transplanted tissue.
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spelling pubmed-93908112022-08-22 Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction Nakano, Takahiko Kudo, Toshiya Sano, Yoshitomo Minehara, Hiroaki Suzuki, Masao Aoki, Kohei Matsushita, Takashi Plast Reconstr Surg Glob Open Reconstructive Although free tissue transplantation (FTT) is an essential technique in extremity functional reconstruction, postoperative blood flow disturbance is one of the critical complications leading to transplanted tissue necrosis. Early detection of this complication may prevent tissue failure by prompt improvement of blood flow. The aim of this study was to determine whether transcutaneous carbon dioxide pressure (TcPCO(2)) monitoring increases the salvage rates after FTT. METHODS: We retrospectively reviewed 75 consecutive patients who underwent FTT for extremity reconstruction with TcPCO(2) monitoring postoperatively between December 2016 and September 2021. RESULTS: Extremity reconstruction was performed in 53 cases due to trauma, 20 cases due to infection, and two cases due to tumor resection for tissue defects. The overall success rate of the FTT was 98.7%, with 13 complications. Of the 11 patients who underwent reoperation, nine had thrombosis and two had vascular strangulation. However, when reoperation was decided, none of the reoperation cases still exhibited any deterioration in the Doppler or clinical assessment. All reoperated cases were salvaged. Of the two patients who did not undergo reoperation, one had failed flaps and one had partial skin necrosis. With a TcPCO(2) cutoff value of 70 mm Hg, the sensitivity and specificity for detecting complications due to impaired blood flow were 100% and 93.5%, respectively. CONCLUSIONS: TcPCO(2) monitoring was performed after FTT for extremity reconstruction, and all cases of reoperation were salvaged. TcPCO(2) monitoring can detect impaired postoperative blood flow critically earlier than clinical assessments and may increase salvage rates of transplanted tissue. Lippincott Williams & Wilkins 2022-08-19 /pmc/articles/PMC9390811/ /pubmed/35999883 http://dx.doi.org/10.1097/GOX.0000000000004467 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Nakano, Takahiko
Kudo, Toshiya
Sano, Yoshitomo
Minehara, Hiroaki
Suzuki, Masao
Aoki, Kohei
Matsushita, Takashi
Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
title Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
title_full Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
title_fullStr Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
title_full_unstemmed Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
title_short Transcutaneous CO(2) Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
title_sort transcutaneous co(2) pressure monitoring increases salvage rates after free tissue transplantation for extremity reconstruction
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390811/
https://www.ncbi.nlm.nih.gov/pubmed/35999883
http://dx.doi.org/10.1097/GOX.0000000000004467
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