Tissue oximetry monitoring in microsurgical breast reconstruction decreases flap loss and improves rate of flap salvage

Background: Since the inception of microvascular free tissue transfer, flap monitoring has been based on clinical signs. Color, capillary refill, and handheld Doppler have been used for monitoring in the postoperative period; however, subjective clinical examination may delay recognition of flap compromise. Tissue oximeter monitoring offers an objective method for detecting vascular compromise with the measurement of tissue oxygen saturation and real-time flap perfusion. Methods: The authors reviewed 614 consecutive microsurgical flaps for breast reconstruction from 2004 to 2010. The authors' first 380 patients underwent clinical flap postoperative monitoring. Starting in June of 2008, the authors used tissue oximetry as an adjunct on 234 consecutive patients. Flap reexploration, flap loss, salvage rate, fat necrosis, and characteristics of vascular compromise were analyzed. Results: There were 26 instances of flap reexploration (6.8 percent) and 11 flap losses (2.9 percent) before use of tissue oximetry. After tissue oximetry was used, there were 16 instances of flap reexploration (6.8 percent) and one flap loss. The rate of flap reexploration was not statistically significant between groups, but the difference between the flap failure rates is significant (p = 0.025). The flap salvage rate was previously 57.7 percent; after tissue oximetry monitoring, the flap salvage rate was 93.75 percent (p = 0.015). Conclusions: The use of tissue oximetry has decreased the authors' flap loss rate and improved the flap salvage rate in microsurgical breast reconstruction. This device is a useful adjunct in flap monitoring during the postoperative period, as it may help decrease flap loss by detecting impending vascular compromise before it becomes clinically evident.