The Predictive Value of Laser Doppler for Flap Survival.

Kim, Seok Kwun; Park, Jung Min; Baek, Chang Yoon; Jung, Gi Hwan; Lee, Keun Cheol; Jung, Jin Suk; Park, Ju In; Park, Byung Ho

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2005;32(4):503-510.
Published online July 1, 2005.

The Predictive Value of Laser Doppler for Flap Survival.

Seok Kwun Kim, Jung Min Park, Chang Yoon Baek, Gi Hwan Jung, Keun Cheol Lee, Jin Suk Jung, Ju In Park, Byung Ho Park

¹Department of Plastic and Reconstructive Surgery, College of Medicine, Dong-A University, Busan, Korea. jmpark@dounet.donga.ac.kr
²Department of Pathology, College of Medicine, Dong-A University, Busan, Korea.
³Department of Biochemistry, College of Medicine, Dong-A University, Busan, Korea.
⁴Department of Diagnostic Radiology, College of Medicine, Dong-A University, Busan, Korea.

Abstract

If we could predict the necrosis of the flap caused by reperfusion injury, we can minimize the necrosis of the flap by taking appropriate action before necrosis begins. In this study, we examined whether we can predict the survival of flap under reperfusion injury or not, by measuring laser doppler flow meter values. We divided the group into the control and experimental groups corresponding to 6, 8, 9, 10, and 12hours after reperfusion(hours after ligation of auricular central artery). In each group, we examined necrotic change, perfusion unit (PU), serum superoxide dismutase (SOD), glutathione peroxidase, angiography and pathologic findings. No necrosis was observed in the 6 and 8 hours group but 8, 18, 20 hours after ligation, necrosis was observed, Also in each of 9, 10 and 12 hours group (each group consisted of 20 flaps), necrosis were noted. According to the above data, the critical time of necrosis in the auricular skin flap model lies between about 8 to 9 hours. Comparing the PU between the necrosis and non-necrosis groups, the former group showed a mean 39.57 PU increase after 60 min of reperfusion, and the latter group showed a mean increase of 21.21 PU. We can conclude that better flow can dilute oxygen free radical into systemic circulation, and this means less injuries are caused on vessels. Our study implies that if blood flow increase is less than 30 PU, intensive care is needed to save the flap. Additionally, we found significant decrease of serum SOD and glutathione peroxidase in the necrotic group. Therefore, monitoring these serum markers will be helpful in predicting reperfusion injury and supplementing these enzymes could be helpful to save the flap. The laser doppler flow meter is thought to be helpful in clinical circumstances for evaluating the circulation of the flap after the operation. However, more accumulation of clinical studies should be necessary establishing useful clinical data.

Keywords: Reperfusion injury; Laser doppler flowmeter value; Perfusion unit; Superoxide dismutase; Glutathione peroxidase

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