Mr. Landon Clark This is Me

Education

 Web References

1. 1. DermatologyTimes - Assess Flap Viability

   www.dermatologytimes.com/derma - [Cached]

   Published on: 11/1/2003   Last Visited: 11/23/2003

   Photograph courtesy of Landon Clark.
   
   New Orleans - A small, hand-held, nonpulsatile, optical diffusion oximeter (FireFly Tissue Oximeter, Spectros) shows promise as a tool for assessing flap viability and, thereby, enabling intraoperative modifications, postoperative revisions, and ultimately outcomes of flap reconstruction surgery, according to the results of a pilot study conducted by researchers in the department of dermatology, Stanford University, Stanford, Calif.
   
   Speaking at the joint annual meeting of the American Society for Dermatologic Surgery/ American College of Mohs Micrographic Surgery and Cutaneous Oncology, Landon Clark, B.S., presented the findings from a study in which the non-contact oximeter was used to measure tissue oxygenation in flaps created for reconstruction of Mohs surgery defects.
   
   Research Findings > Clark is currently a fourth-year medical student at Stanford and conducted the study while participating in a dermatologic surgery research fellowship under the direction of Hayes B. Gladstone, M.D., director of the division of dermatologic surgery.
   ...
   Mr. Clark
   
   "This tissue oximeter features a very small spot size that makes it very useful for obtaining highly localized readings of oxygen tension when designing and raising flaps. The results of this preliminary study are encouraging and justify further investigation of its utility for routine use intraoperatively to evaluate flap viability as well as for postoperative monitoring to facilitate early identification of flaps destined for failure that might benefit from timely revision. For the time being, however, the available data seem adequate to support the use of this tissue oximeter to evaluate particularly large flaps and those at risk for failure because of a compromised blood supply," Mr. Clark said.
   ...
   "The data obtained with this device are operator-independent and also not subject to confounding by such artifacts as tissue movement," Mr. Clark said.
   
   Study Details > The study was comprised of a series of about 20 flaps, including advancement, island pedicle, rotation, transposition, and rhombic flaps. Each was measured at the following sites after both flap elevation and suturing: the point of maximal tension; the most proximal and distal aspects; and the central body. In addition, a control skin site was measured, and the oximetry evaluations were repeated at one week after surgery.
   
   The results of the intraoperative measurements showed that for each type of flap, the lowest oxygen saturation level was at the point of maximum tension. Considering all of the sites measured for each type of flap, the rhombic flaps were generally associated with the lowest initial levels of oxygen saturation followed by the bilateral advancement flaps, while the rotation flaps exhibited the best oxygenation. Comparisons based on data measured at the point of maximum tension and the central portion showed that the transposition flaps had the lowest oxygen tension at those sites.
   
   "These results are understandable and consistent with our expectations based on consideration of tissue oxygenation at different sites within a particular flap and the vascular supply of different flap types," Mr. Clark said.
   
   The hand-held probe of the FireFly tissue oximeter. Photograph courtesy of Landon Clark
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   "In retrospect, while we didn't modify flap design in any case, that might be something to consider more strongly when oxygen saturations are particularly low and not improved with additional undermining in an attempt to improve flap viability and provide the patient with a better result," Mr. Clark said.