Lee DW, Hwang YS, Byeon JY, Kim JH, Choi HJ. Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction? World J Clin Cases 2023; 11(31): 7570-7582 [PMID: 38078127 DOI: 10.12998/wjcc.v11.i31.7570]
Corresponding Author of This Article
Hwan Jun Choi, MD, PhD, Professor, Surgeon, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Suncheonhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, South Korea. iprskorea@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2023; 11(31): 7570-7582 Published online Nov 6, 2023. doi: 10.12998/wjcc.v11.i31.7570
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
Da Woon Lee, Yong Seon Hwang, Je Yeon Byeon, Jun Hyuk Kim, Hwan Jun Choi, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
Author contributions: Lee DW and Choi HJ contributed to the conceptualization and methodology of this study; Lee DW participated in the formal analysis, visualization, and writing-original draft preparation of this article; Byeon JY and Hwang YS involved in the investigation of this manuscript; Byeon JY and Kim JH contributed to the resources; Lee DW and Hwang YS participated in the data curation; Kim JH and Choi HJ contributed to the supervision; Choi HJ contributed to the project administration and funding acquisition; and all authors have read and agreed to the published version of the manuscript.
Supported bythe National Research Foundation of Korea Grant funded by the Korean government (MSIT) (2020R1A2C1100891 and 2021R1G1A1008337); and the Soonchunhyang University Research Fund.
Institutional review board statement: The study protocol was approved by the Institutional Review Board (number:2022-12-043-003).
Informed consent statement: The patient provided informed consent for the publication.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available from the authors upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hwan Jun Choi, MD, PhD, Professor, Surgeon, Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Suncheonhyang 6-gil 31, Dongnam-gu, Cheonan-si 31151, South Korea. iprskorea@gmail.com
Received: September 14, 2023 Peer-review started: September 14, 2023 First decision: September 19, 2023 Revised: September 25, 2023 Accepted: October 23, 2023 Article in press: October 23, 2023 Published online: November 6, 2023 Processing time: 52 Days and 11.7 Hours
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.
Core Tip: Transcutaneous oxygen pressure (TcpO2) is measured low in free flap (FF) reconstruction for the following reasons. The flap itself is thick, making it difficult to accurately measure TcpO2, the adventitia stripping that occurs during vessel anastomosis semi-permanently reducing the sympathetic tone of the entire vessel, and the arteriovenous shunt caused by performing FFs and the progression of diabetes, thought to occur. For this reason, long-term periodic TcpO2 measurement is not useful when FF reconstruction is performed on diabetic foot ulcer.
