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Q: How many beds and how many patients per year do you have in your unit?
A: 18 beds+3 hotel beds. Patients per year: 700-900.
Q: What year did you start to use microdialysis?
A: I started to use microdialysis September 1998
Q: How many patients do you estimate that you have run microdialysis on since the start?
A: 240 patients
Q: In average how many patients per year do you use Microdialysis on and what kind of flaps are you monitoring?
A: For now it is an average of 30 to 40 patients per year. I am using microdialysis as standard monitoring method for all my free flaps: pure muscle, musculocutaneous, DIEP, fibula (pure bone and osteocutaneous) and jejunal flap. I do not use other monitoring methods. I do not use clinical monitoring as long as the microdialysis is functioning. I use microdialysis for flaps in the open as well as for buried flaps.
Q: What sample interval do you normally have?
A: For the first 24 hours after revascularization the sample interval is 30 minutes. For the next 24 hours it is every hour, and thereafter the interval is 2 hours. That is if the case is uncomplicated.
Q: Do you treat your patients based on the Microdialysis results?
A: Yes, as long as the microdialysis is functioning, I totally rely on the values.
Q: What ischemic pattern and threshold values trigger a re-operation?
A: I always look at the glucose and the lactate values. As a standard the nurses call the doctor on duty in case the glucose is below 1 or 2mM (depending on the case) and the lactate is beyond 10mM. The situation is revisited, and it is confirmed, that the patient is doing all right with normal BP, adequate positioning, no sign of haematoma, and so on.
If everyting is all right, and the values continue to deteriorate, we often re-operate. Glucose below 0.1mM and lactate above 15 are for me a sign to call in the nurses for a re-operation. If there isn’t concordance between the glucose and the lactate concentrations, I look at the glycerol as a sign of cell destruction, and maybe I calculate ratios.
Q: Do you consider microdialysis monitoring in free flaps feasible in a clinical routine setting?
A: YES!
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