The holy grail of flap monitoring is an easy, reliable and predictive method to identify impending compromise. Does this paper provide it? Various methods have been used to improve our ability to monitor the viability of a flap and here the use of skin prick glucose measurement is used. The authors present their method of measuring skin prick blood glucose at 0, 6, 12, 24 and 48 hours postoperatively and compared these results with clinical assessments and overall flap failure. The study included 127 flaps and the data presented is comprehensive with good methodology. They have calculated that a blood glucose value of 62mg/dL provided an overall diagnostic accuracy of 87%. The paper does include pedicled as well as free flaps and data from non-head and neck flaps. How applicable the study is when the data is limited to the 25 head and neck free flaps remains to be seen. The results provide an interesting benchmark for further studies but do not provide help for the buried head and neck reconstructive flap where skin prick monitoring is not possible.
Identifying early flap failure
Reviewed by Stuart Burrows
Diagnostic accuracy of blood glucose measurements in detecting venous compromise in flaps.
CONTRIBUTOR
Stuart Burrows
FRCS (ORL-HNS), Wellington Regional Hospital, Newtown, Wellington, New Zealand.
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