Abstract: A Novel Text Messaging Alert System Used with Continuous Tissue Oximetry Monitoring to Improve Free Flap Outcomes (Plastic Surgery The Meeting)

Sunday, September 25, 2016: 1:50 PM

Joseph A. Ricci, MD , Division of Plastic and Reconstructive Surgery, Beth Isreal Deaconess Medical Center / Harvard Medical School, Boston, MA

Christina R Vargas, MD , Department of Surgery, Beth Israel Deaconess Medical Center / Harvard Medical School, Boston, MA

Adam M Tobias, MD , Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center / Harvard Medical School, Boston, MA

Samuel J Lin, MD, MBA , Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center / Harvard Medical School, Boston, MA

Amir H Taghinia, MD, MBA , Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA

Bernard T Lee, MD, MBA, MPH , Division of Plastic Surgery, Beth Israel Deaconess Medical Center / Harvard Medical School, Boston, MA

Presentation PDF file

Purpose: The time to detection of flap compromise is a significant predictor of flap salvage outcomes and earlier detection of vascular compromise of a free flap allows for earlier exploration and improved opportunity for salvage. Near-infrared tissue oximetry is an objective, quantitative method of detecting flap vascular compromise and has been shown to allow earlier detection and higher salvage than clinical assessment alone. To further improve the effectiveness of such devices, we describe the use of a novel programming of these devices to send text message alerts directly to surgeons, notifying them instantly of a change in oximetry levels.

Methods: All consecutive microsurgical free flaps for breast reconstruction at a single institution from February 2004 to October 2015 were reviewed. Continuous near-infrared tissue oximetry (Vioptix; Freemont, CA) was utilized to detect failing free flaps and patients were divided based on whether text message alerts were employed or not. A novel text messaging system was programmed to send alert messages when the tissue oximetry readings suggested potential flap compromise. The program was based on previous thresholds of an absolute value less than 30% or a 20% drop in tissue oxygenation over a one hour period. Rates of re-exploration and flap salvage were compared.

Results: A total of 614 flaps (68.2%) received Vioptix monitoring, and 286 flaps (31.8%) received additional text messaging alerts. There was no difference in the groups with respect to the rates of complete or partial flap loss, return to the operating room or other complications. However, on average, unplanned returns to the operating room were observed to occur sooner in the text message alert group compared to the standard group (18 hours postop vs. 27 hours postop).

Conclusions: Although, no statistically significant difference was observed between the groups with respect to complications, the inclusion of text message alerts used in conjunction with continuous tissue oximetry in the postoperative monitoring protocol of microsurgical free tissue transfer for breast reconstruction hold promise for an even greater improvement in flap salvage rates as failing flaps can be identified sooner.

29854 A Novel Text Messaging Alert System Used with Continuous Tissue Oximetry Monitoring to Improve Free Flap Outcomes