Online rapid sampling microdialysis (rsMD) using enzyme-based electroanalysis for dynamic detection of ischaemia during
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ORIGINAL PAPER
Online rapid sampling microdialysis (rsMD) using enzymebased electroanalysis for dynamic detection of ischaemia during free flap reconstructive surgery M. L. Rogers & P. A. Brennan & C. L. Leong & S. A. N. Gowers & T. Aldridge & T. K. Mellor & M. G. Boutelle
Received: 30 September 2012 / Revised: 18 January 2013 / Accepted: 20 January 2013 / Published online: 26 February 2013 # The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract We describe an enzyme-based electroanalysis system for real-time analysis of a clinical microdialysis sampling stream during surgery. Free flap tissue transfer is used widely in reconstructive surgery after resection of tumours or in other situations such as following major trauma. However, there is a risk of flap failure, due to thrombosis in the flap pedicle, leading to tissue ischaemia. Conventional clinical assessment is particularly difficult in such ‘buried’ flaps where access to the tissue is limited. Rapid sampling microdialysis (rsMD) is an enzyme-based electrochemical detection method, which is particularly suited to monitoring metabolism. This online flow injection system analyses a dialysate flow stream from an implanted microdialysis probe every 30 s for levels of glucose and lactate. Here, we report its first use in the monitoring of free flap reconstructive surgery, from flap detachment to revascularisation and overnight in the intensive care unit. The on-set of ischaemia by both arterial clamping and failure of venous drainage was seen as an increase in lactate and decrease in glucose levels. Glucose levels returned to normal within 10 min of successful arterial anastomosis, whilst lactate took longer to clear. The use of the lactate/glucose ratio provides a clear predictor of ischaemia on-set and subsequent recovery, as it is insensitive to changes in blood flow such as Published in the topical collection Bioelectroanalysis with guest editors Nicolas Plumeré, Magdalena Gebala, and Wolfgang Schuhmann. M.L. Rogers and P.A. Brennan have contributed equally to this work. M. L. Rogers : C. L. Leong : S. A. N. Gowers : M. G. Boutelle (*) Department of Bioengineering, Imperial College, London SW7 2AZ, UK e-mail: [email protected] P. A. Brennan : T. Aldridge : T. K. Mellor Maxillofacial Department, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
those caused by topical vasodilators, like papaverine. The use of storage tubing to preserve the time course of dialysate, when technical difficulties arise, until offline analysis can occur, is also shown. The potential use of rsMD in free flap surgery and tissue monitoring is highly promising. Keywords Microdialysis . Free tissue transfer . Glucose . Lactate . Real time . Ischaemia
Introduction Despite the increasing sophistication of modern surgical procedures, complications such as the development of ischaemia due to a disrupted blood supply are relatively common and difficult to detect. If such complications are detected, further emergency surgical intervention may be r
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