2020 Volume 33 Issue 2 Pages 70-74
Gustilo type ⅢB and ⅢC lower extremity fractures require reconstruction of the damaged soft tissue free flap during the early stages of fracture. Congestion is an early complication of free flap surgery. To detect congestion due to venous thrombosis, it is necessary to evaluate flap blood flow. The purpose of this study was to detect congestion early and save free flaps. The measurements were compared between patients who presented with congestion and those without congestion. The 17 limbs with open lower leg and foot fractures included in this study had their fracture sites covered by the free flap. Our approach involved performing a pinprick test, and measuring blood glucose and lactate levels using a portable instrument. We identified 11 flaps without congestion and 6 flaps with congestion. The 6 flaps with congestion had a low mean capillary blood glucose measurement index of 0.57 (range 0.79 to 0.3) in their congested flaps and an increased mean lactate level of 11.4 mmol/L (range 8.3 to 17.9 mmol/L). The 6 flaps survived. Monitoring both flap blood glucose and lactate levels enables the early detection of congestion.
