信頼性の高い持続的遊離皮弁モニタリングのための低温度下経皮的二酸化炭素分圧測定 : 動物実験と臨床経験
Flap Monitoring by TcPCO2
Goishi, Keiichi The University of Tokushima
柏木, 圭介 The University of Tokushima
Yamano, Masahiro The University of Tokushima
Background: Measurement of transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) has been used for free flap monitoring. Because these values are obtained with sensor probes heated to 44°C, there is potential for low-temperature burns on skin flaps. We measured TcPO2 and TcPCO2 at 37°C in both animals and humans to determine the feasibility and safety of the procedure as a postoperative flap monitoring method.
Methods: Twelve epigastric island flaps were elevated in rabbits, and TcPO2 and TcPCO2 were measured at 37°C before and after ligation of the pedicles. In addition, TcPO2 and TcPCO2 at 37°C were measured in healthy men. Subsequently, the method was applied to postoperative monitoring of free flaps in 49 clinical cases.
Results: TcPO2 and TcPCO2 values were significantly affected by the experimental flap elevation. A rapid increase in TcPCO2 was observed with both arterial and venous occlusion. In the healthy men, TcPO2 and TcPCO2 were measurable at all skin surface sites. In the clinical cases of free flap transfer, TcPO2 values remained very low for at least 72 hours. TcPCO2 values ranged from 40 to 70 mmHg for 72 hours in more than 80% of cases. In 2 cases, TcPCO2 values increased to more than 90 mmHg, and exploration surgery was performed. These compromised flaps were saved by reanastomosis of the veins.
Conclusions: Continuous monitoring of TcPCO2 at 37°C can provide objective information and alert doctors and nurses to the need for checking the free flap.
Plastic and Reconstructive Surgery : Global Open
Wolters Kluwer Health
内容要旨・審査要旨 : LID201310041001.pdf
内容要旨・審査要旨 : LID201406051002.pdf
本論文は, 著者Yoshiro Abeの学位論文として提出され, 学位審査・授与の対象となっている。
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LID201310041001.pdf 178 KB
LID201406051002.pdf 1020 KB