MCH THESIS ABSTRACT ims sum hospital - Copy.pptx

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1. Objective evaluation of flap survival by capillary glucose monitoring – a prospective study Dr.PRAGADA SUSMITHA M.Ch Resident Department of Plastic and Reconstructive surgery Guide Dr.Susant Mishra ( Professor and HOD)

2. INTRODUCTION Flap surgery has become a reliable method of reconstruction. It allows repair of postsurgical and posttraumatic defects almost over any part of the body with vascularized tissue(1). Vascular compromise (venous>arterial) is the most common cause for flap loss . [ 2,3,4,5] Scrupulous postoperative flap monitoring allows early detection of flap failure which is the only evidence‑ based strategy for optimizing free flap salvage The rate of flap salvage declines as the duration of the time period from the occurrence of the complication to its detection increases.

3. There are various methods available for flap monitoring. Classically, post‑ operative vascular perfusion is assessed by clinical observation of the flap which includes the color, temperature, turgor , capillary refill, and pinprick/dermal scratch test. Microdialysis is a method that measures certain metabolites like glucose, lactate, etc., levels in the flap blood. It is a more objective, reliable, and reproducible method documented in the literature for postoperative monitoring of free flaps / pedicled flaps . Based on the principles of microdialysis , monitoring of capillary glucose levels in free flaps/ pedicled using glucometer is being proposed as a cheap, rapid, and simple method for the early prediction of microvascular complications and thereby reducing flap failure(6).

4. AIMS AND OBJECTIVES PRIMARY OUTCOMES : To assess the efficacy of capillary glucose level and its diagnostic validity in the post-operative monitoring of pedicled flap and free flap tranfer . SECONDARY OUTCOME : To intervene as early as possible to salvage the flap.

5. INCLUSION AND EXCLUSION CRITERIA INCLUSION CRITERIA : All patients undergoing pedicled /free flaps. EXCLUSION CRITERIA : All patients with buried flap . Patient with Comorbidities such as chronic smoker , patients of vasculitis , or any other vasculopathy .

6. METHODOLOGY STUDY DESIGN : PROSPECTIVE STUDY STUDY GROUPS : All patients who underwent pedicled flap and free tissue flaps in Burns,Plastic &Reconstructive Surgery Department of IMS & SUM Hospital were assessed post operatively and followed to 5 th post operative day . SAMPLE SIZE : A convenience sampling will be done over the period of two years( as per the hospitals previous statistics) which will be not less than 30 cases.

7. PROCEDURE Patient who underwent free tissue tranfer / pedicled flaps , flap blood glucose levels were measured at scheduled times by glucometer . Samples are taken in immediate post operative period then after 1,6,24,48,72 hrs after operation. Capillary blood samples are taken by the pinprick method at the distal most part of the flap and measuring by glucometer . A routine baseline capillary glucose level measurement was also done in all patients.

8. STATISTICAL ANALYSIS A convenience sampling will be done over period of two years and data collected. The collected data variables will be analysed using Chi Sqaure test and Diagnosed performance of test .

9. REFERENCES 1. Yadav P. Head and neck reconstruction. Indian J Plast Surg 2013;46:275‑82. 2) Wu CC, Lin PY, Chew KY, Kuo YR. Free tissue transfers in head and neck reconstruction: Complications, outcomes and strategies for management of flap failure: Analysis of 2019 flaps in single institute. Microsurgery 2014;34:339‑44. 3). Yu P, Chang DW, Miller MJ, Reece G, Robb GL. Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction. Head Neck 2009;31:45‑51. 4). Chiu YH, Chang DH, Perng CK. Vascular complications and free flap salvage in head and neck reconstructive surgery: Analysis of 150 cases of reexploration . Ann Plast Surg 2017;78:S83‑8. 5). Pohlenz P, Klatt J, Schön G, Blessmann M, Li L, Schmelzle R. Microvascular free flaps in head and neck surgery: Complications and outcome of 1000 flaps. Int J Oral Maxillofac Surg 2012;41:739‑43. 6) Hara H, Mihara M, Iida T, Narushima M, Todokoro T, Yamamoto T, et al. Blood glucose measurement for flap monitoring to salvage flaps from venous thrombosis. J Plast Reconstr Aesthet Surg 2012;65:616‑9 .