Peri-operative Tissue Oximetry Driven Fluid Resuscitation Improves Flap Perfusion In Autologous Free Tissue Breast Reconstruction: A Prospective Study
Efstathios Karamanos, MD1, Hassan Ahmad, MD2, Rajaie Hazboun, MD1, Melinda Lue, BA1, Noah Saad, MD1, Howard Wang, MD1.
1UT Health San Antonio Long School of Medicine, San Antonio, TX, USA, 2Texas Tech Health Sciences Center, Lubbock, TX, USA.
PURPOSE: The use of tissue oximetry for monitoring following free tissue transfer has become a common practice to facilitate early detection of poor flap perfusion. We hypothesized that T stat readings may guide fluid administration in the post-operative period and improve perfusion in patients undergoing autologous breast reconstruction.
METHODS: Patients undergoing free flap breast reconstruction from 2015-2018 were reviewed. Mean percutaneous oximetry readings of the first 4 post-operative days were recorded. The mean change at 24 hours from the original reading was calculated (ΔTO). The study population was divided in two groups based on whether administration of intravenous fluids (IVF) was increased/maintained (group 1) or decreased (group 2) after POD 1.
RESULTS: A total of 120 patients were identified. The mean age was 53, while the mean BMI was 33. Overall, patients for whom fluid administration was decreased, experienced an increase in their tissue perfusion while patient who received a bolus or maintained the same rate of IVF experienced a decrease. Patients who had a negative ΔTO experienced a statistically significant difference between the groups 1 and 2 at 24 and 72 hours (-4 versus +3 and -11 versus +13 respectively). For patients with a positive ΔTO, while decreasing fluids resulted in higher readings, it did not reach statistical significance at 24 or 72 hours (0 versus +2 and +4 versus +6 respectively).
CONCLUSION: In patients undergoing free tissue breast reconstruction, tissue oximetry readings may be used as a novel guide for post-operative fluid management.
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