Das postoperative Monitoring von (frei) vaskularisierten Knochentransplantaten zur Rekonstruktion von Knochendefekten

Vascularized bone transplantation for reconstruction of bone defects remains a great challenge for experienced microsurgeons. The clinical evidence of a well-vascularized bone graft is key for the postoperative rehabilitation strategy. Especially the early postoperative period is decisive for the outcome of surgery. Continuous monitoring systems, e.g., the monitoring skin island, may be distinguished from noncontinuous monitoring systems, e.g., MRI. Techniques to monitor the free flap or graft depend on location and tissue composition. Several techniques have been described to monitor the postoperative viability of microsurgical free vascularized grafts, including surface or temporarily implanted Doppler, dynamic MRI, angiography or scinitgraphy, and many other techniques. The sensitivity and reliability of these techniques continue to be the subject of animal experiments and clinical trials. The optimal monitoring device should be objective, noninvasive, safe, reproducible, easily managed and interpretable for the nursing staff, and a clear indicator of changes in arterial and venous circulation. Presently, none of the techniques fulfill all of the criteria completely. The relative advantages and disadvantages of these various postoperative monitoring techniques are discussed.