Prospective analysis of flap perfusion by measuring capillary glucose level in flaps
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Post-operative monitoring of flap is equally important as harvesting of a flap. Early diagnosis of flap failure can salvage the flap by appropriate intervention. The monitoring methods used should be rapid, inexpensive, and accurate. The purpose of this study is to evaluate the usefulness of blood glucose monitoring (BGM) of the flap as our monitoring modality.
This study includes 60 flaps which were monitored by measuring their capillary glucose level by pricking the distal end of the flap. Out of the 60 flaps, 18 were free flaps, 23 were pedicled, and 19 were of the random variety. Quantitative data was expressed in frequency, percentage, mean value, and standard deviation for capillary glucose levels of the flap.
Out of the 60 flaps, 44 survived well, 10 flaps were having minor distal necrosis (< 10% of flap area), major flap necrosis occurred in 3 flaps while 3 flaps failed completely. Failed flaps have shown lower glucose levels. Using the receiver operating characteristic curve (ROC), the cutoff value for BGM was 61 mg/dl, with a sensitivity of 93% and a specificity of 80%.
Blood glucose monitoring reveals the state of perfusion of the flap in the postoperative period. Flap capillary glucose levels less than 61 mg/dl is suggestive of ischemia of the flap with a sensitivity and a specificity of 93% and 80%, respectively. It has prognostic value as it allows early detection of vascular compromise and also defines the forthcoming line of demarcation in partial necrosis.
Level of Evidence: Type IV, diagnostic study.
KeywordsBlood glucose monitoring Hypoperfusion Demarcation Ischemia Flap prognosis
Compliance with ethical standards
This study is funded by Institutional Review Board, Christian Medical College, Vellore Tamil Nadu (India).
Conflict of interest
Mukesh Kumar Sharma, Geley Ete, Gaurav Chaturvedi, Elvino Barreto, and Kingsly Paul Meetper Doss declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
Patients provided written consent for the use of their images.
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