Intraoperative evaluation of perfusion in free flap surgery: A systematic review and meta-analysis

Jan Maerten Smit, Vera L. Negenborn, Sanne M. Jansen, Mariëlle E.H. Jaspers, Ralph de Vries, Martijn W. Heymans, Hay A.H. Winters, Ton G. van Leeuwen, Margriet G. Mullender, Nicole M.A. Krekel

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Free flap survival relies on adequate tissue perfusion. We aim to give an overview of the available literature of all objective methods to intraoperatively assess free flap tissue perfusion, and the effects on (partial) flap loss. Methods: A systematic review and meta-analysis according to the PRISMA guidelines was performed (PubMed, Cochrane Library, Embase) regarding English language articles. Meta-analyses were performed by pooling means and slopes using random-effect models. Results: Sixty-four articles were included reporting on 2369 procedures in 2009 patients with various indications. Reported methods were fluorescence imaging (FI), laser Doppler, oxygen saturation, ultrasound, (dynamic) infrared thermography, venous pressure, and microdialysis. Intraoperative tissue perfusion was adequately measured by the use of FI and laser Doppler, leading to surgical intervention or altered flap design, and increased flap survival. Meta-analysis showed a mean time until onset of the dye to become visible of 18.4 (7.27; 29.46, Q P<0.001) sec. The relative intensity of the flap compared to the intensity curve of normal tissue was 75.92% (65.85; 85.98, Q P=0.719). The mean difference in the slope value of the oxygen tensions before and after the anastomosis was -0.09 (-0.12; -0;06 Q P=0.982). No convincing evidence was found for the use of other methods. Conclusions: Based on the current literature, FI and laser Doppler are most suitable to intraoperatively measure free flap tissue perfusion, resulting in improved flap survival. However, this review was limited by the available literature. Additional studies are necessary to investigate the predictive value of intraoperative perfusion measurement.

Original languageEnglish
Pages (from-to)804-818
Number of pages15
JournalMicrosurgery
Volume38
Issue number7
DOIs
Publication statusPublished - 1 Oct 2018

Cite this

Smit, Jan Maerten ; Negenborn, Vera L. ; Jansen, Sanne M. ; Jaspers, Mariëlle E.H. ; de Vries, Ralph ; Heymans, Martijn W. ; Winters, Hay A.H. ; van Leeuwen, Ton G. ; Mullender, Margriet G. ; Krekel, Nicole M.A. / Intraoperative evaluation of perfusion in free flap surgery : A systematic review and meta-analysis. In: Microsurgery. 2018 ; Vol. 38, No. 7. pp. 804-818.
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title = "Intraoperative evaluation of perfusion in free flap surgery: A systematic review and meta-analysis",
abstract = "Background: Free flap survival relies on adequate tissue perfusion. We aim to give an overview of the available literature of all objective methods to intraoperatively assess free flap tissue perfusion, and the effects on (partial) flap loss. Methods: A systematic review and meta-analysis according to the PRISMA guidelines was performed (PubMed, Cochrane Library, Embase) regarding English language articles. Meta-analyses were performed by pooling means and slopes using random-effect models. Results: Sixty-four articles were included reporting on 2369 procedures in 2009 patients with various indications. Reported methods were fluorescence imaging (FI), laser Doppler, oxygen saturation, ultrasound, (dynamic) infrared thermography, venous pressure, and microdialysis. Intraoperative tissue perfusion was adequately measured by the use of FI and laser Doppler, leading to surgical intervention or altered flap design, and increased flap survival. Meta-analysis showed a mean time until onset of the dye to become visible of 18.4 (7.27; 29.46, Q P<0.001) sec. The relative intensity of the flap compared to the intensity curve of normal tissue was 75.92{\%} (65.85; 85.98, Q P=0.719). The mean difference in the slope value of the oxygen tensions before and after the anastomosis was -0.09 (-0.12; -0;06 Q P=0.982). No convincing evidence was found for the use of other methods. Conclusions: Based on the current literature, FI and laser Doppler are most suitable to intraoperatively measure free flap tissue perfusion, resulting in improved flap survival. However, this review was limited by the available literature. Additional studies are necessary to investigate the predictive value of intraoperative perfusion measurement.",
author = "Smit, {Jan Maerten} and Negenborn, {Vera L.} and Jansen, {Sanne M.} and Jaspers, {Mari{\"e}lle E.H.} and {de Vries}, Ralph and Heymans, {Martijn W.} and Winters, {Hay A.H.} and {van Leeuwen}, {Ton G.} and Mullender, {Margriet G.} and Krekel, {Nicole M.A.}",
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Intraoperative evaluation of perfusion in free flap surgery : A systematic review and meta-analysis. / Smit, Jan Maerten; Negenborn, Vera L.; Jansen, Sanne M.; Jaspers, Mariëlle E.H.; de Vries, Ralph; Heymans, Martijn W.; Winters, Hay A.H.; van Leeuwen, Ton G.; Mullender, Margriet G.; Krekel, Nicole M.A.

In: Microsurgery, Vol. 38, No. 7, 01.10.2018, p. 804-818.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Intraoperative evaluation of perfusion in free flap surgery

T2 - A systematic review and meta-analysis

AU - Smit, Jan Maerten

AU - Negenborn, Vera L.

AU - Jansen, Sanne M.

AU - Jaspers, Mariëlle E.H.

AU - de Vries, Ralph

AU - Heymans, Martijn W.

AU - Winters, Hay A.H.

AU - van Leeuwen, Ton G.

AU - Mullender, Margriet G.

AU - Krekel, Nicole M.A.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Free flap survival relies on adequate tissue perfusion. We aim to give an overview of the available literature of all objective methods to intraoperatively assess free flap tissue perfusion, and the effects on (partial) flap loss. Methods: A systematic review and meta-analysis according to the PRISMA guidelines was performed (PubMed, Cochrane Library, Embase) regarding English language articles. Meta-analyses were performed by pooling means and slopes using random-effect models. Results: Sixty-four articles were included reporting on 2369 procedures in 2009 patients with various indications. Reported methods were fluorescence imaging (FI), laser Doppler, oxygen saturation, ultrasound, (dynamic) infrared thermography, venous pressure, and microdialysis. Intraoperative tissue perfusion was adequately measured by the use of FI and laser Doppler, leading to surgical intervention or altered flap design, and increased flap survival. Meta-analysis showed a mean time until onset of the dye to become visible of 18.4 (7.27; 29.46, Q P<0.001) sec. The relative intensity of the flap compared to the intensity curve of normal tissue was 75.92% (65.85; 85.98, Q P=0.719). The mean difference in the slope value of the oxygen tensions before and after the anastomosis was -0.09 (-0.12; -0;06 Q P=0.982). No convincing evidence was found for the use of other methods. Conclusions: Based on the current literature, FI and laser Doppler are most suitable to intraoperatively measure free flap tissue perfusion, resulting in improved flap survival. However, this review was limited by the available literature. Additional studies are necessary to investigate the predictive value of intraoperative perfusion measurement.

AB - Background: Free flap survival relies on adequate tissue perfusion. We aim to give an overview of the available literature of all objective methods to intraoperatively assess free flap tissue perfusion, and the effects on (partial) flap loss. Methods: A systematic review and meta-analysis according to the PRISMA guidelines was performed (PubMed, Cochrane Library, Embase) regarding English language articles. Meta-analyses were performed by pooling means and slopes using random-effect models. Results: Sixty-four articles were included reporting on 2369 procedures in 2009 patients with various indications. Reported methods were fluorescence imaging (FI), laser Doppler, oxygen saturation, ultrasound, (dynamic) infrared thermography, venous pressure, and microdialysis. Intraoperative tissue perfusion was adequately measured by the use of FI and laser Doppler, leading to surgical intervention or altered flap design, and increased flap survival. Meta-analysis showed a mean time until onset of the dye to become visible of 18.4 (7.27; 29.46, Q P<0.001) sec. The relative intensity of the flap compared to the intensity curve of normal tissue was 75.92% (65.85; 85.98, Q P=0.719). The mean difference in the slope value of the oxygen tensions before and after the anastomosis was -0.09 (-0.12; -0;06 Q P=0.982). No convincing evidence was found for the use of other methods. Conclusions: Based on the current literature, FI and laser Doppler are most suitable to intraoperatively measure free flap tissue perfusion, resulting in improved flap survival. However, this review was limited by the available literature. Additional studies are necessary to investigate the predictive value of intraoperative perfusion measurement.

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U2 - 10.1002/micr.30320

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