Blood pressure and free flap oxygenation in head and neck cancer patients

Abstract

Conclusion: This study suggests that although oxygen partial pressure in tissue (p _tiO₂) measurement is a feasible method for continuous postoperative monitoring of free flaps, low correlation between blood pressure (BP) and p _tiO₂ might predict compromised overall outcome. Thus, it is of utmost importance to keep the BP optimal for adequate perfusion of re-anastomosed tissue transfers. Objective: Optimal BP is an important factor in assuring adequate blood flow in a free flap. Tissue oxygenation in free flaps as a postoperative monitoring target is in routine clinical use in some clinics. Correlation between p _tiO₂ and systemic BP was investigated. Methods: Ten consecutive patients underwent resection of head and neck squamous cell carcinoma followed by microvascular reconstruction with a free microvascular flap. P _tiO₂ of each flap was continuously monitored for 3 postoperative days with a polarographic measurement system. BP was measured invasively and continuously during the operation and during the first postoperative day at the intensive care unit. The correlation coefficient between p _tiO₂ and BP was analysed. Results: The correlation coefficient between p _tiO₂ and BP was relatively high in all patients with uneventful flap survival (r _mean = 0.63, n = 5). In flaps with haemodynamic problems or compromised flap vitality the correlation appeared low (r _mean = –0.02, n = 5).

Keywords::

• Postoperative monitoring
• tissue oxygenation

Acknowledgments

This work was conducted as part of routine departmental audit activities. A.S. and I.K. have full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Declaration of interest: The authors report no conflicts of interest. The authors are responsible for the content and writing of the paper.