Flap and finger-tip blood glucose level monitoring to predict venous thrombosis in free flaps: a simple and effective method

Background: Rapid detection and early re-exploration is the key to salvage congested flap. Various methods have been described in literature to monitor flaps in post operative period. We evaluate the efficacy of measurement of flap and fingertip blood glucose level and its role in predicting the flap congestion and salvage. Methods: prospective observational study conducted in a tertiary care centre in North India between December 2020 to December 2022. A total of patients 500 underwent 507 free tissue transfer were included in this study. Flap congestion was noted clinically in 41 flaps. In these 41 flaps, flap and fingertip blood glucose level were measured. Results: Congested appearing flaps divided into 2 groups. Group A consist of 8 flaps out of 41. The difference in flap and fingertip blood glucose level is less than 10%. Out of 8, 5 does not required re-exploration and were successfully salvaged. In 3 flaps, difference in flap and fingertip glucose level rises with time and were taken for re-exploration. Out of these 3, 2 were successful salvaged. Group B consist of 31 flaps. In these 31 flaps, 41. the difference in flap and fingertip blood glucose level is more than 10%. All these flaps were re-explored and 21 were salvaged. Conclusions: Flap and body glucose level monitoring is a simple and reliable method for flap monitoring and it can be performed by residents as well as nursing staff.