Introduction: Free flaps, such as the transverse rectus abdominis myocutaneous (TRAM) flap, are frequently used in breast reconstruction following mastectomy. While the majority of flaps do well, the consequences of flap failure can be devastating. Early recognition of vascular problems post-operatively is vital if a failing flap is to be salvaged.
Aim of the Study: This study has assessed the potential of lightguide spectrophotometry (LGS) to detect early vascular compromise following TRAM breast reconstruction and compared this with clinical observation and laser Doppler flowmetry.
Materials and Methods: Fourteen patients (mean age 45 years) were studied on return from theatre up to 70 hours post-operatively (mean 45 hours). In all patients laser Doppler flowmetry and tissue oxygen saturation were recorded. In later patients an additional parameter, the haemoglobin index (HbI, proportional to haemoglobin concentration) was also measured.
Results: The equipment was well tolerated by all patients. Tissue oxygen saturation accurately reflected clinical outcome and compared favourably with laser Doppler. Furthermore the HbI appears to offer the potential to differentiate between arterial and venous vascular occlusion. Technical equipment failures occurred in 2 patients and occasional, temporary detachments of the probes in 3. One flap failed.
Discussion: While a critical alarm value for tissue oxygen saturation has yet to be established, these preliminary results show an encouraging correlation between LGS readings and both clinical outcome and laser Doppler. The increased sensitivity of the tissue oxygen saturation measurement at low flow when compared to laser Doppler reflects the improved potential this instrument may have for free flap monitoring.
Caddick J, Raine C, Harrison D, Erdmann M. Lightguide spectrophotometry to monitor free TRAM flaps. Adv Exp Med Biol: 578: 351-356.
Dr. David K. Harrison, Durham Unit, Durham. Tel: +44 (0)191-333-2215.
Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
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