Chapter 4 Figure 4.5 Lower blood flow 1–5 h after reperfusion precedes FC. In zone IV a lower blood flow was measured during the first 5 hours after reperfusion (P=0.013). This lower blood flow was measured before FC was clinically evident. The increase in blood flow on the second to third day was observed only in zone IV. This indicates a delayed opening of choke vessels. In addition, LDF was particularly accurate in detecting arterial occlusion at a very early stage. In two patients, LDF showed ischemic values in zone I (three to four arbitrary units) at 1 h after reperfusion. Patients were still in the operating theatre and the anastomosis was re‐evaluated and revealed in both cases a twist of the artery. After repositioning the artery, the blood flow was restored and there was no need to revise the anastomosis in both cases. Discussion The LDF is presented as a valuable and non‐invasive research tool to investigate ischemia‐related changes that occur in the distal part of the flap in a clinical setting. A significant lower blood flow was measured in zone IV during the first 5 hours after reperfusion in patients with FC (Figure 4.5). The patients with FC also appeared to have a lower flap temperature compared to those without (Figure 4.2). This slightly lower skin flap temperature is probably a consequence of the lower perfusion which was measured with LDF. At this stage (first 5 h after reperfusion) clinical signs were not visible at the measurement sites. One point measurement analysis during surgery (LDF prior to division of its pedicle and 1 h after reperfusion) revealed no significant differences between patients with FC compared to those without FC. Therefore the LDF can be used as an investigative tool 64
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