الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Pedicled flaps are still an important way to fix things, even though microvascular reconstruction with free flaps is used a lot. These flaps work well and don’t need the special care that free flaps do after surgery. In general, there can be trouble with these flaps.
Such complications include dehiscence of wound, infection, partial or complete loss of flap. Such complications generally occur within the first 4 weeks after surgery.
Most flap failures are caused by a buildup of blood in the veins. This problem can be caused by a number of things, such as the way the veins are set up., venous spasm, venous thrombosis, local edoema or pedicle torsion.
Several ways to keep an eye on flaps have been described, such as a physical assessment of the flap’s colour, turgor, capillary refilling, temperature, and pin pricking. However, when clinical signs of venous congestion show up, it is often too late to use these methods and they need to be done by an experienced observer. So, researchers are looking into ways to monitor and find early signs of flap venous congestion. The implantable Doppler system, colour duplex sonography, near infrared spectroscopy, microdialysis, and laser Doppler flowmetry are some of these methods. , PH measurement, hydrogen clearance, transcutaneous oxygen tension photoplethysmography.
Monitoring methods need to be simple, early to perform, harmless to patient, reliable, portable, capable of being used by all personnel and cost effective.
The microdialysis system, which shows metabolic changes in flaps, has shown that in congestive and ischemic conditions, the amount of blood glucose in flaps goes down. . So flap blood glucose level measurement is proposed to be simple, easy, and inexpensive method.
Aim of the study to evaluate the use of the blood glucose level measurement as an easy, inexpensive and not painful method of monitoring pedicled flaps and early detection of venous congestion.
This prospective clinical study was conducted on 20 patients in Minia University Hospital who underwent reconstruction using pedicled flaps and monitoring using blood glucose level measurement. In the current study the number of included patients was 20 patients but the numbers of performed flaps were 21 flaps. The study duration ranged from 6-12 months.
The main results of the study revealed that:
The current study included 20 patients; 14 of them were males (70%) and 6 were females (30%). Their age ranged from 6 years to 50 years.
The most frequent sites for flap inset were the leg and fingers/toes in 19% for each followed by foot, hand and back in 14.3% for each. Other exposed areas were tendon and bone in 4 cases for each while both tendon and bone were exposed in 1 case.
Flap glucose monitoring is as effective tool as clinical monitoring for detection of venous congestion at the site of flap insertion with no statistically significant difference between using blood glucose monitor or clinical monitor for detection of venous congestion. Persistently low glucose level at the site of flap inset was detected in all cases that developed clinical evidence of venous congestion. Dropped glucose level at the site of flap inset revealed DROP of the glucose level in 14 patients. This DROP was transient in 4 of them and improved without need for intervention. The remaining 10 patients developed persistent low glucose level at the flap site and during follow up clinical signs of venous congestion become evident so intervention was done.
Monitoring of glucose level at the site of flap inset and the difference between glucose measurement at normal skin and flap showed statistically significant earlier detection of evidence of venous congestion by using glucose monitoring than by development of clinical signs. There was no statistically significant difference between flap glucose monitoring values of congested flaps who were detected by glucose monitor and those who were detected clinically.
Using ROC curve, the Sensitivity and Specificity of glucose difference of cutoff value -47 mg/dl needed for intervention were the highest 93.3%& 83.3%.
Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.