|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
|Postoperative evaluation of vascular patency and tissue perfusion is an essential element in the management of microsurgical cases. Early detection of vascular occlusion or tissue ischemia is a signal for the initiation of salvage strategies. Loosening of splints and dressings, changes in position and temperature, pharmacologic therapy, and operative re-exploration can be systematically considered once postoperative perfusion problems are recognized.
Characteristics of a successful microsurgical postoperative monitoring technique include reliability, specificity, safety for the patient and the monitored tissue, and simplicity. Many means of monitoring are available, ranging from direct clinical observation to sophisticated electronic inferential systems. The number of described approaches indicates that none is perfect for all circumstances.
To summarize described monitoring techniques, we divided the techniques into four groups. Each group contains monitoring techniques that focus on a specific aspect of postoperative examination: clinical observation, patency of pedicle or axial vessels, indicators of tissue circulation, and metabolic indices related to tissue perfusion (Table 37-1 ). Within each of these general categories, the mechanism and application of each monitoring strategy or device is briefly described.
The techniques and technologies of postoperative monitoring are evolving in many research and clinical settings. This discussion is not intended as a final word in any specific area of monitoring but as a framework to define current theory and application.
Clinical evaluation requires no specialized equipment, but does rely heavily on the experience and diligence of a trained observer. Important physical signs include the quality of capillary filling, bleeding from a cut edge of replanted or transferred tissue, and tissue turgor.
A pale, cool digit without capillary refill implies an arterial inflow problem; a rigid, blue digit with rapid refill implies venous insufficiency. A pink color with 1-to-2-second refill is consistent with good perfusion.
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