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Three-Year Experience Using Near Infrared Spectroscopy Tissue Oximetry Monitoring of Free Tissue Transfers

Steele, Matthew H. MD

doi: 10.1097/SAP.0b013e31820909f9
Clinical Paper

Early recognition of threatened free-flap failure is paramount to flap salvage. A noninvasive, reproducible, sensitive monitoring tool would be a useful adjunct to clinical examination. The purpose of this study was to examine outcomes using a near-infrared spectroscopy (NIRS) tissue oximeter for postoperative flap monitoring. A total of 128 free flaps were performed in 113 patients over a 3 year period. The patients were divided into 2 cohorts: conventional monitoring (group 1) and conventional monitoring plus NIRS oximetry (group 2). Overall flap survival was 90.6% in group 1 and 98.7% in group 2 (P = 0.05). Overall survival of threatened flaps was 0% (0/5) in the conventional group and 87.5% (6/7) in the oximeter group, P = 0.005. Salvage of operated flaps was significantly improved in group 2: 0% (0/4) in group 1 versus 100% (3/3) in group 2, P = 0.03. The sensitivity, specificity, and predictive values for detecting threatened flap loss were 100%. The NIRS tissue oximeter is a highly reliable, sensitive, and specific, noninvasive method for postoperative free tissue transfer monitoring.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL.

Received November 28, 2010, and accepted for publication, after revision, November 29, 2010.

Presented at the Southeastern Society of Plastic and Reconstructive Surgeons 53rd Annual Scientific Meeting, Palm Beach, FL, June 13, 2010.

Reprints: Matthew H. Steele, MD, Division of Plastic Surgery, University of Florida College of Medicine, 1600 SW Archer Road, MSB 6th Floor, M-612, PO Box 100138, Gainesville, FL 32610. E-mail:

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