Plastic Surgery Research Council
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Presenter: Johnny T Chang, MD, MSME
Co-Authors: Safa B; Parrett BM; Buncke GM; Buntic RF
The Buncke Clinic at California Pacific Medical Center

Purpose: Current techniques for monitoring free tissue transfers and replants continue to plague microsurgeons with false predictions. No technique provides reliable, objective data for detecting both arterial and venous compromise. Over a period of nearly 30 years, serial quantitative fluorimetry with microdose fluorescein has enabled us to quickly diagnose or rule out perfusion disturbances in the face of false predictions from pencil Doppler, implantable Doppler, and clinical assessments. We now present the largest study to date of quantitative fluorimetry, with over 8300 readings.

Methods: All patients who underwent replantation or free tissue transfer with skin or fasciocutaneous flaps from March through December, 2010, were enrolled. Quantitative fluorimetry was performed every 2 hours for the first 24-48 hours postoperatively, then tapered according to clinical indications. Each set of measurements consisted of readings at zero, 10, and 60 minutes after injecting a microdose of fluorescein. Sensitivity, specificity, and positive and negative predictive values were calculated.

Results: A total of 8300 quantitative fluorimetry readings were obtained in 65 patients. Of those patients, 15 had free tissue transfers; two had digital artery reconstruction for nontraumatic ischemia; the rest underwent replantation or revascularization. Quantitative fluorimetry demonstrated a sensitivity of 100%, specificity of 99%, negative predictive value of 100%, and positive predictive value of 88% for detecting arterial or venous compromise. There were no complications due to fluorescein administration.

Discussion: Quantitative fluorimetry rapidly and reliably predicts vascular compromise or patency. It compares favorably with existing modalities in detecting pedicle thrombosis. Moreover, it provides specific knowledge about arterial versus venous compromise. Most importantly, fluorimetry accurately confirmed vascular patency with a negative predictive value of 100%. When fluorimetry indicates adequate circulation, the microsurgeon can rest comfortably and avoid unnecessary operative re-exploration.

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