Does the systemic rise in serum lactate levels correlate to free flap failure in head and neck reconstructive surgeries—series of cases

Nikhar, Sapna Annaji; Metta, Rajasekhar; Nimmagadda, Raja; Gopinath, R.

doi:10.1186/s42077-023-00370-2

Does the systemic rise in serum lactate levels correlate to free flap failure in head and neck reconstructive surgeries—series of cases

Authors

10.1186/s42077-023-00370-2

Abstract

Background
Head and neck reconstructive surgeries needs free tissue transfer but it fails sometimes. As most of the flap failure occurs in first 24 h. Local rise in lactate level or glucose lactate ratio provides clear indicator of tissue ischemia and further recovery. The question is about systemic rise in lactate levels with failing flap. Hence, we aimed to use systemic lactate levels to indicate free flap failure. To correlate the systemic rise in serum lactate levels to free flap failure in head and neck reconstructive surgeries. The series of cases were targeted undergoing free fibular graft, posted electively for head and reconstructive surgery operated by same surgeon. Record of blood loss, need of blood transfusion and use of microspan was also done. Monitoring of arterial blood gas values mainly lactate and vitals were done.
Results
Out of 15 patients studied, only 2(13.3%) patients had flap re-exploration (group F). Twelve (80%) patients were of ASA class I. Lactate, pH, blood sugars, base deficits and hemoglobin and vitals studied over 24 h in two groups had no statistically significant difference in the two groups. Lactate rise was noted in all cases for first few hours after starting surgery but elevated values were not observed during hours of flap re-exploration.
Conclusions
We could not establish relation between systemic rise in lactate levels and flap re-exploration or flap failure but continuous acidosis can impact outcome. We need to be vigilant and need to have individualized approach for management.

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