Plastic Surgery Research Council
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A PROSPECTIVE STUDY OF TRANSIT TIME FLOW VOLUME (TTFV) MEASUREMENT FOR INTRA-OPERATIVE EVALUATOIN AND OPTIMIZATION OF FREE FLAPS
Presenter: Jesse Selber, MD
Co-Authors: Garvey PB; Clemens MW; Chang EI; Zhang H; Hanasono MW
University of Texas MD Anderson Cancer Center

Background: Transit time flow volume (TTFV) measurement, a non-Doppler-based ultrasound technology, has been shown to accurately evaluate the quality of coronary artery bypass grafts and improve outcomes of cardiac surgery. We hypothesized that TTFV measurements would also improve decision-making in microvascular free tissue transfer procedures.

Methods: We measured TTFV in 52 consecutive free flaps. Measurements were recorded at three times: In Situ, after flap elevation and isolation on its pedicle; Time 1, immediately following anastomosis and reperfusion; and Time 2, 30 minutes following anastomosis and reperfusion. Intra-operative decisions based on TTFV were documented.

Results: Arterial inflow was on average 1.5 times greater than venous outflow, and arterial resistance was 3.59 times greater than venous resistance. Free transverse rectus abdominis musculocutaneous flaps had the highest venous and arterial flows, and free radial forearm flaps had the lowest. Compared to the baseline (In Situ) measurement, all flaps had higher flows immediately after transfer (Time 1) (p<0.0001), but no significant differences were seen 30 minutes later (Time 2) (p=0.68). Arterial resistance, however, increased during that interval (p=0.006). Operative decisions, including selection of the higher-flow vena comitans (sometimes the smaller of the two), and when to revise an anastomosis, were modified on the basis of TTFV findings in 19 (36.5%) of 52 cases.

Conclusion: TTFV provides novel physiologic flap data and identifies flawed anastomoses and higher-flow venae comitantes. These data have clinical value in microsurgery and hold the potential to reduce microvascular complications and improve outcomes.


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