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Using blood glucose and lactate levels for early detection of venous congestion following a free flap procedure for lower extremity open fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Gustilo–Anderson type IIIB and IIIC open fractures of the lower extremities require reconstruction of extensively injured soft tissues using a free flap; however, impaired blood flow through the flap is an early postoperative complication. To detect flap congestion due to venous thrombosis, blood glucose and lactate level measurements within the flap are taken to determine variations in these levels. We aimed to detect early-stage venous congestion and to perform salvage operations.

Methods

We included 22 limbs with lower leg and foot open fractures, with fracture sites covered using a free flap. A pinprick test was used to measure blood glucose and lactate levels.

Results

Of 7 and 15 congested and non-congested limbs, respectively, the 7 congested limbs had a mean flap blood glucose level immediately before salvage surgery of 3.8 ± 2.0 (7.4–1.8) mmol/L. The ratio to blood glucose levels in healthy fingertips was 0.6 ± 0.2 (0.8–0.3). Lactate levels increased to 13.3 ± 5.1 (9.4–22.8) mmol/L. The ratio of blood glucose levels in congested flaps and in healthy fingertips was significantly lower than that in non-congested flaps and in healthy fingertips (p = 0.0016). Lactate levels were significantly higher in patients with congestion (p = 0.0013). Salvage surgery was performed, thrombi were removed, and six limb flaps were viable.

Conclusion

Flap blood glucose and lactate levels provide a quantitative method of evaluating blood flow and detecting flow abnormalities postoperatively, and are useful in detecting early congestion due to venous thrombosis.

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References

  1. Papakostidis C, Kanakaris NK, Pretel J, et al. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo–Anderson classification. Injury. 2011;42(12):1408–15.

    Article  Google Scholar 

  2. Thakore RV, Francois EL, Nwosu SK, et al. The Gustilo–Anderson classification system as predictor of nonunion and infection in open tibia fractures. Eur J Trauma Emerg Surg. 2017;43(5):651–6.

    Article  CAS  Google Scholar 

  3. Court-Brown CM, Bugler KE, Clement ND, et al. The epidemiology of open fractures in adults. A 15-year review. Injury. 2012;43(6):891–7.

    Article  Google Scholar 

  4. Culliford AT IV, Spector J, Blank A, et al. The fate of lower extremities with failed free flaps: a single institution’s experience over 25 years. Ann Plast Surg. 2007;59(1):18–21.

    Article  CAS  Google Scholar 

  5. Setala L, Gudaviciene D. Glucose and lactate metabolism in well-perfused and compromised microvascular flaps. J Reconstr Microsurg. 2013;29(8):505–10.

    Article  Google Scholar 

  6. Guillier D, Moris V, Cristofari S, et al. Monitoring of myocutaneous flaps by measuring capillary glucose and lactate levels: experimental study. Ann Plast Surg. 2018;80(4):416–23.

    Article  CAS  Google Scholar 

  7. Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am. 1990;72(2):299–304.

    Article  CAS  Google Scholar 

  8. Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esfhet. 2000;45(3):346–53.

    CAS  Google Scholar 

  9. Henault B, Pluvy I, Pauchot J, et al. Capillary measurement of lactate and glucose for free flap monitoring. Ann Chir Plast Esthet. 2014;59(1):15–21.

    Article  CAS  Google Scholar 

  10. Sakurai H, Nozaki M, Takeuchi M, et al. Monitoring the changes in intraparenchymatous venous pressure to ascertain flap viability. Plast Reconstr Surg. 2007;119(7):2111–7.

    Article  CAS  Google Scholar 

  11. Heller L, Levin LS, Klitzman B. Laser Doppler flowmeter monitoring of free-tissue transfers: blood flow in normal and complicated cases. Plast Reconstr Surg. 2001;107(7):1739–45.

    Article  CAS  Google Scholar 

  12. Liu DZ, Mathes DW, Zenn MR, et al. The application of indocyanine green fluorescence angiography in plastic surgery. J Reconstr Microsurg. 2011;27(6):355–64.

    Article  CAS  Google Scholar 

  13. Jyränki J, Suominen S, Vuola J, et al. Microdialysis in clinical practice: monitoring intraoral free flaps. Ann Plast Surg. 2006;56(4):387–93.

    Article  Google Scholar 

  14. Tachi K, Nakatsukasa S, Nakayama Y. Monitoring free flap venous congestion using continuous tissue glucose monitoring: a case report. JPRAS. 2018;17(17):49–53.

    Google Scholar 

  15. Brown JS, Devine JC, Magennis P, et al. Factors that influence the outcome of salvage in free tissue transfer. Br J Oral Maxillofac Surg. 2003;41(1):16–20.

    Article  CAS  Google Scholar 

  16. Bui DT, Cordeiro PG, Hu QY, et al. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119(7):2092–100.

    Article  CAS  Google Scholar 

  17. Bigdeli AK, Gazyakan E, Schmidt VJ, et al. Long-term outcome after successful lower extremity free flap salvage. J Reconstr Microsurg. 2019;35(4):263–9.

    Article  Google Scholar 

  18. Setälä L, Papp A, Romppanen EL, et al. Microdialysis detects postoperative perfusion failure in microvascular flaps. J Reconstr Microsurg. 2006;22(2):87–96.

    Article  Google Scholar 

  19. Kishi K, Ishida K, Makino Y, et al. A simple way to measure glucose and lactate values during free flap head and neck reconstruction surgery. J Oral Maxillofac Surg. 2019;7(1):226.e1-9.

    Article  Google Scholar 

  20. Mochizuki K, Mochizuki M, Gonda K. Flap blood glucose as a sensitive and specific indicator for flap venous congestion: a rodent model study. Plast Reconstr Surg. 2019;144(3):409e-e418.

    Article  CAS  Google Scholar 

  21. Hara H, Mihara M, Iida T, et al. Blood glucose measurement for flap monitoring to salvage flaps from venous thrombosis. J Plast Reconstr Aesthet Surg. 2012;65(5):616–9.

    Article  Google Scholar 

  22. Hara H, Mihara M, Iida T, et al. Blood glucose measurement in flap monitoring for salvage of flaps from venous thrombosis. Plast Reconstr Surg. 2012;129(3):587e-e589.

    Article  Google Scholar 

  23. Karakawa R, Yoshimatsu H, Narushima M, et al. Ratio of blood glucose level change measurement for flap monitoring. Plast Reconstr Surg Glob Open. 2018;6(7):e1851.

    Article  Google Scholar 

  24. Sakakibara S, Hashikawa K, Omori M, et al. A simplest method of flap monitoring. J Reconstr Microsurg. 2010;26(7):433–4.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Yuka Kobayashi, Yoshiyasu Uchiyama & Masahiko Watanabe

  2. Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Tokyo, Japan

    Takayuki Ishii, Daisuke Nakajima & Syou Yanagisawa

  3. Department of Orthopaedic Surgery, Isehara Kyodo Hospital, Kanagawa, Japan

    Ikuo Saito

Authors
  1. Yuka Kobayashi
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  2. Yoshiyasu Uchiyama
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  3. Takayuki Ishii
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  4. Daisuke Nakajima
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  5. Syou Yanagisawa
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  6. Ikuo Saito
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  7. Masahiko Watanabe
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YK, YU, TI, DN, SY, IS and MW. The first draft of the manuscript was written by YK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuka Kobayashi.

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Conflict of interest

The authors report no conflict of interest.

Ethical approval

The study design was approved by the Ethics Committee of the Tokai University School of Medicine (Reception No. 16R-196).

Consent to participate

Patients and their families provided informed consent to participate after receiving a thorough explanation of the study.

Consent for publication

Patients and their families provided informed consent after a thorough explanation of the study regarding the publication of their photographs and data.

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Kobayashi, Y., Uchiyama, Y., Ishii, T. et al. Using blood glucose and lactate levels for early detection of venous congestion following a free flap procedure for lower extremity open fractures. Eur J Trauma Emerg Surg 48, 2493–2501 (2022). https://doi.org/10.1007/s00068-021-01831-9

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  • DOI: https://doi.org/10.1007/s00068-021-01831-9

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