Abstract
In reconstructive microsurgery, flap failure can be catastrophic to the patient. Different
monitoring methods have been implemented in an attempt to recognize secondary ischemia
during its early stages. However, the exact onset of secondary ischemia can be difficult
to determine because there are no well-documented and reliable monitoring techniques
that offer true continuous monitoring in a clinical setting. Because of the uncertain
time in terms of the onset of secondary ischemia, the exact length of ischemia before
revascularization, the secondary ischemia time, cannot be obtained. This is probably
part of the reason why not much has been published regarding the effect of secondary
ischemia time in reference to flap survival. We present a case of a free gracilis
muscle flap that was salvaged despite more than 11 hours of arterial ischemia. The
flap was monitored using microdialysis and at no time was the ischemia clearly demonstrated
by clinical inspection. We conclude that clinical monitoring in some cases can be
an unreliable method for monitoring free muscle transfers suffering from arterial
ischemia and that further studies are needed for more specific guidelines regarding
the critical secondary ischemia time in muscle flaps.
Keywords
microsurgery - monitoring - microdialysis - muscle - ischemia
