# Flap size as a confounding variable in flap perfusion measurement with the Oxygen-to-see (O2C) analysis system in microvascular head and neck reconstruction – a retrospective analysis

## TL;DR

This study shows that flap size does not affect perfusion measurements using the O2C system in head and neck reconstruction.

## Contribution

The study demonstrates that flap size is not a confounding variable in O2C-based perfusion monitoring.

## Key findings

- Hemoglobin concentration at 2-mm depth differed between small and large ALTFs, but not for RFFFs.
- Differences in hemoglobin concentration persisted in multivariable analysis for ALTFs.
- Flap size does not affect blood flow or oxygen saturation measurements with the O2C system.

## Abstract

The Oxygen-to-see (O2C) analysis system is used for flap monitoring based on predefined threshold values for flap perfusion. However, flap size may be a confounding variable. The aim of this study was to investigate the relationship between flap size and flap perfusion in microvascular head and neck reconstruction.

Flap perfusion values measured with the O2C analysis system between 2011 and 2020 in 252 patients undergoing microvascular head and neck reconstruction with a radial free forearm flap (RFFF) or anterolateral thigh flap (ALTF) were retrospectively analyzed. Intraoperative and postoperative flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation at 8- and 2-mm tissue depths were compared between small (≤ median flap size) and large flaps (> median flap size) for RFFFs and ALTFs separately.

Intraoperative and postoperative hemoglobin concentration at a 2-mm tissue depth differed between small and large ALTFs (65.0 arbitrary units [AU] vs. 51.0 AU, p = 0.007; and 51.5 AU vs. 39.0 AU, p = 0.019). Both differences persisted in multivariable analysis (p < 0.001 and p = 0.012). Other differences were not observed or did not persist in multivariable analysis for RFFFs and ALTFs (all p > 0.05).

Microvascular free flap perfusion is not related to flap size in terms of flap blood flow and hemoglobin oxygen saturation. This underscores the validity of predefined absolute threshold values in the context of flap monitoring based on perfusion measurement with the O2C analysis system.

Flap perfusion measurement with the Oxygen-to-see (O2C) analysis system can be used for flap monitoring of small and large flaps.