Monitoring Interstitial Glucose Changes During Ischemia/Reperfusion in Human Cutaneous Free Flaps
Keywords:
free flap, monitoring, interstitial glucose, ischemia/reperfusionAbstract
Background: Free tissue transfer has unique post ischemic tissue metabolism that resembles theischemia/reperfusion model. Glucose regulation during ischemia/reperfusion and effects of the insult to
glucose metabolism in various human skin flaps were examined in this study by using the continuous glucose
monitoring device.
Methods: Seven cutaneous-containing free flaps reconstruction were performed in seven adult patients.
Interstitial glucose within the flaps was monitored using a transcutaneous sensor. Interstitial glucose (ISG) was
recorded from flap harvesting until one hour following arterial anastomosis. Interstitial glucose concentrations
and trends were reported.
Results: Six free flaps were successfully monitored according to study protocol. The initial mean ISG in
the flap was 111.219± 26.33 (59.5-129) mg/dl. The glucose average rate of fall was 1.04 mg/min after pedicle
transection. Average time to reach low plateau phase (47.49± 13.98% of initial ISG) was 87± 42.16 minutes. The
mean ischemic time was 165.83± 53.88 (105-237) minutes. After arterial reperfusion, the interstitial glucose rose
in the average rate of 0.79 mg/min. The 1-hr post-reperfusion ISG remained stable at 87.5± 6.85% (75.51-94.1)
of the initial (p = 0.01). Weak negative correlation between ischemic time and 1-hr post-reperfusion ISG was
observed (r = -0.59).
Conclusions: Interstitial glucose concentration in human skin flap during ischemia/reperfusion episode
is correlated with tissue perfusion. Prolonged ischemia compromises glucose metabolism in the early reperfusion
period.
Keywords:
References
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Plast Surg 2006;57:431-4.
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interstitial versus blood glucose monitoring. Diabetes
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21. Battelino T, Bolinder J. Clinical use of real-time continuous
glucose monitoring. Curr Diabetes Rev 2008;4:218-22.
22. Hoopes J, Im M. Skin flap necrosis in guinea pigs limitation of
glucose supply and accumulation of lactate. Plast
Reconstr Surg 1978.
23. Im M, Su C, Hoopes J. Skin-flap metabolism in rats: Oxygen
consumption and lactate production. Plast Reconstr Surg
1983.
24. Blomqvist L, Malm M. Metabolism in myocutaneous flaps
studied by in situ microdialysis. J Plast Surg 1998;2:27-34.
25. Setäalä LP, Korvenoja EM-L, Härmä M a, Alhava EM, Uusaro
A V, Tenhunen JJ. Glucose, lactate, and pyruvate response
in an experimental model of microvascular flap ischemia
and reperfusion: a microdialysis study. Microsurgery
2004;24:223-31.
26. Laure B, Sury F, Bayol J-C, Goga D. Microdialysis: experience
in postoperative monitoring of 30 free flaps. Ann de Chirurgie
Plastique et Esthétique 2009;54:29-36.
27. Carroll WR, Esclamado RM. Ischemia/reperfusion injury in
microvascular surgery. Head Neck 2000;22:700-13.
28. Stephenson LL, Zamboni WA. Experimental timing of
microcirculatory injury from ischemia reperfusion. 2000;785-
8.
29. Fitzal F, Valentini D, Mittermayr R, Worseg a, Gasser IH, Redl
H. Circulatory changes after prolonged ischemia in the
epigastric flap. J Reconstr Microsurg 2001;17:535-43.
oxygenation and perfusion by near-infrared reflection
spectroscopy and color-coded duplex sonography. Plastic
Reconstructive Surg 2004;113:141-52.
2. Siemionow M, Arslan E. Ischemia/reperfusion injury: a review
in relation to free tissue transfers. Microsurgery. Wiley Online
Library 2004;24:468-75.
3. Wang WZ, Baynosa RC, Zamboni WA. Update on ischemiareperfusion
injury for the plastic surgeon: 2011. Plast Reconstr
Surg 2011;128:685e-92e.
4. Wang W. Investigation of reperfusion injury and ischemic
preconditioning in microsurgery. Microsurgery 2009;29:72-9.
5. Eisenhardt SU, Schmidt Y, Karaxha G, Iblher N, Penna V,
Torio-Padron N, et al. Monitoring Molecular Changes
Induced by Ischemia/Reperfusion in Human Free Muscle
Flap Tissue Samples. Ann Plast Surg 2012;68:202-8.
6. Edsander-nord Å, Ph D, Röjdmark J, Wickman M.
Experimental Metabolism in Pedicled and Free TRAM Flaps:
a Comparison Using the Microdialysis Technique. Plast
Reconstr Surg 2001;664-73.
7. Gebhard MM, Germann G. Experimental Ischemic
Preconditioning by Brief Extremity Ischemia before Flap
Ischemia in a Rat Model. Plast Reconstr Surg. 2001;2398-404.
8. Küntscher M V, Hartmann B, Germann G. Remote ischemic
preconditioning of flaps: a review. Microsurgery 2005;25:346-
52.
9. Coskunfirat OK, Ozkan O, Dikici MB. The effect of ischemic
preconditioning on secondary ischemia in skin flaps. Ann
Plast Surg 2006;57:431-4.
10. Moon JG, Lim HC, Gye MR, Oh JS, Park JW. Postconditioning
attenuates ischemia-reperfusion injury in rat skin flap.
Microsurgery 2008;28:531-7.
11. Kraemer R, Lorenzen J, Kabbani M, Herold C, Busche M,
Vogt PM, et al. Acute effects of remote ischemic
preconditioning on cutaneous microcirculation - a controlled
prospective cohort study. BMC Surg 2011;11:32.
12. Minh TC, Ichioka S, Nakatsuka T, Kawai J, Shibata M, Ando
J, et al. Effect of hyperthermic preconditioning on the
survival of ischemia-reperfused skin flaps: a new skin-flap
model in the mouse. J Reconstr Microsurg 2002;18:115-9.
13. Izquierdo R, Swartz WM, Sutker KB, Boydell CL, Almand J.
Attenuation of Reperfusion-induced Lipoperoxidation by
Systemic Use of Oxygen Radical Scavengers after Pedicle
Occlusion. Ann Plast Surg 1992;28:175.
14. Cordeiro PG, Lee JJ, Mastorakos D, Hu QY, Pinto JT,
Santamaria E. Prevention of ischemia-reperfusion injury in a
rat skin flap model: the role of mast cells, cromolyn sodium,
and histamine receptor blockade. Plast Reconstr Surg
2000;105:654-9.
15. Jyränki J, Suominen S, Vuola J, Bäck L. Microdialysis in clinical
practice: monitoring intraoral free flaps. Ann Plast Surg
2006;56:387-93.
16. Smit JM, Zeebregts CJ, Acosta R, Werker PMN.
Advancements in free flap monitoring in the last decade: a
critical review. Plast Reconstr Surg 2010;125:177-85.
17. Sitzman TJ, Hanson SE, King TW, Gutowski K a. Detection of
flap venous and arterial occlusion using interstitial glucose
monitoring in a rodent model. Plast Reconstr Surg
2010;126:71-9.
18. Vrancic C, Fomichova A, Gretz N, Herrmann C, Neudecker
S, Pucci A, et al. Continuous glucose monitoring by means
of mid-infrared transmission laser spectroscopy in vitro.
The Analyst 2011;136:1192-8.
19. Schoonen AJM, Wientjes KJC. A model for transport of
glucose in adipose tissue to a microdialysis probe. Diabetes
Technol Ther 2003;5:589-98.
20. Cengiz E, Tamborlane WV. A tale of two compartments:
interstitial versus blood glucose monitoring. Diabetes
Technol Ther 2009;11 Suppl 1:S11-6.
21. Battelino T, Bolinder J. Clinical use of real-time continuous
glucose monitoring. Curr Diabetes Rev 2008;4:218-22.
22. Hoopes J, Im M. Skin flap necrosis in guinea pigs limitation of
glucose supply and accumulation of lactate. Plast
Reconstr Surg 1978.
23. Im M, Su C, Hoopes J. Skin-flap metabolism in rats: Oxygen
consumption and lactate production. Plast Reconstr Surg
1983.
24. Blomqvist L, Malm M. Metabolism in myocutaneous flaps
studied by in situ microdialysis. J Plast Surg 1998;2:27-34.
25. Setäalä LP, Korvenoja EM-L, Härmä M a, Alhava EM, Uusaro
A V, Tenhunen JJ. Glucose, lactate, and pyruvate response
in an experimental model of microvascular flap ischemia
and reperfusion: a microdialysis study. Microsurgery
2004;24:223-31.
26. Laure B, Sury F, Bayol J-C, Goga D. Microdialysis: experience
in postoperative monitoring of 30 free flaps. Ann de Chirurgie
Plastique et Esthétique 2009;54:29-36.
27. Carroll WR, Esclamado RM. Ischemia/reperfusion injury in
microvascular surgery. Head Neck 2000;22:700-13.
28. Stephenson LL, Zamboni WA. Experimental timing of
microcirculatory injury from ischemia reperfusion. 2000;785-
8.
29. Fitzal F, Valentini D, Mittermayr R, Worseg a, Gasser IH, Redl
H. Circulatory changes after prolonged ischemia in the
epigastric flap. J Reconstr Microsurg 2001;17:535-43.
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Published
2012-12-28
How to Cite
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Jirawatnotai S, Tanjapatkul R. Monitoring Interstitial Glucose Changes During Ischemia/Reperfusion in Human Cutaneous Free Flaps. Thai J Surg [Internet]. 2012 Dec. 28 [cited 2024 Nov. 6];33(4). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227144
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