Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?

Da Woon Lee; Yong Seon Hwang; Je Yeon Byeon; Jun Hyuk Kim; Hwan Jun Choi

doi:10.12998/wjcc.v11.i31.7570

Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?

World J Clin Cases. 2023 Nov 6;11(31):7570-7582. doi: 10.12998/wjcc.v11.i31.7570.

Authors

Da Woon Lee¹, Yong Seon Hwang¹, Je Yeon Byeon¹, Jun Hyuk Kim¹, Hwan Jun Choi²

Affiliations

¹ Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea.
² Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea. iprskorea@gmail.com.

Abstract

Background: Transcutaneous oxygen pressure (TcpO₂) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors.

Aim: To evaluate the usefulness of TcpO₂ measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).

Methods: TcpO₂ was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.

Results: Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO₂ values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg.

Conclusion: Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO₂ values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO₂ measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.

Keywords: Arteriovenous shunt; Blood gas monitoring; Diabetic angiopathies; Diabetic neuropathies; Free tissue flaps; Surgical; Sympathectomy; Transcutaneous.