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At least 595 records · Page 33Linked to original sources
PubMed1998

Cancer mortality in relation to monitoring for radionuclide exposure in three UK nuclear industry workforces.

Cancer mortality in 40,761 employees of three UK nuclear industry facilities who had been monitored for external radiation exposure was examined according to whether they had also been monitored for possible internal exposure to tritium, plutonium or other radionuclides (uranium, polonium, actinium or other unspecified). Death rates from cancer were compared both with national rates and with rates in radiation workers not monitored for exposure to any radionuclides. Among workers monitored for tritium exposure, overall cancer mortality was significantly below national rates [standardized mortality ratio (SMR) = 83, 165 deaths; 2P = 0.02] and none of the cancer-specific death rates was significantly above either the national average or rates in non-monitored workers. Although the overall death rate from cancer in workers monitored for plutonium exposure was also significantly low relative to national rates (SMR = 89, 581 deaths; 2P = 0.005), mortality from pleural cancer was significantly raised (SMR = 357, nine deaths; 2P = 0.002); none of the rates differed significantly from those of non-monitored workers. Workers monitored for radionuclides other than tritium or plutonium also had a death rate from all cancers combined that was below the national average (SMR = 86, 418 deaths; 2P = 0.002) but prostatic cancer mortality was raised both in relation to death rates in the general population (SMR = 153, 37 deaths; 2P = 0.02) and to death rates in radiation workers who had not been monitored for exposure to any radionuclide [rate ratio (RR) = 1.65; 2P = 0.03]. Mortality from cancer of the lung was also significantly increased in workers monitored for other radionuclides compared with those of radiation workers not monitored for exposure to radionuclides (RR = 1.31, 164 deaths; 2P = 0.01). For cancers of the lung, prostate and all cancers combined, death rates in monitored workers were examined according to the timing and duration of monitoring for radionuclide exposure, with rates of radiation workers not monitored for any radionuclide forming the comparison group. In tritium-monitored workers, RRs for prostatic cancer varied significantly according to the number of years in which they were monitored (2P = 0.03). In workers monitored for plutonium exposure, RRs for all cancers combined increased with the number of years in which they were monitored (2P = 0.04) and with the number of years since first monitoring (2P = 0.0003). There was little suggestion of systematic variation in RRs for workers monitored for other radionuclides in relation to the timing or duration of monitoring, nor did it appear that their raised rates of cancer of the lung and prostate were explained by external radiation dose. These analyses of cancer mortality in relation to monitoring for radionuclide exposure reported in a large cohort of nuclear industry workers suggest that certain patterns of monitoring for some radionuclides may be associated with higher death rates from cancers of the lung, pleura, prostate and all cancers combined. Some of these findings may be due to chance. Moreover, because of the paucity of related data and lack of information about other possible exposures, such as whether plutonium workers are more likely to be exposed to asbestos, firm conclusions cannot be drawn at this stage. Further investigations of the relationship between radionuclide exposure and cancer in nuclear industry workers are needed.

Adolescent↗
PubMed2001

Underestimation of nocturnal hypoxemia due to monitoring conditions in patients with COPD.

STUDY OBJECTIVES: COPD patients run a risk of developing nocturnal oxygen desaturation. When evaluating patients with nocturnal hypoxemia, an unfamiliar hospital environment and the monitoring equipment may cause sleep disturbances. It was hypothesized that increased sleep disruption will lead to fewer instances of desaturation during a night of monitoring. DESIGN: The following forms of monitoring were evaluated prospectively on 3 nights for each patient: oximetry at home; polysomnography (PSG) at home; and PSG in the hospital. SETTING: Department of Pulmonology, Rijnstate Hospital Arnhem, The Netherlands. PATIENTS: Fourteen stable COPD patients (7 men; median age, 71.5 years; age range, 59 to 81 years; FEV(1), 32.5% predicted; FEV(1) range, 19 to 70% predicted) participated in the study. All subjects had significant instances of nocturnal arterial oxygen desaturation. Those patients with a sleep-related breathing disorder or cardiac failure were excluded from the study. MEASUREMENTS AND RESULTS: The mean nocturnal arterial oxygen saturation (SaO(2)) level was higher during PSG monitoring at home (89.7%; range, 77 to 93%) than during oximetry monitoring (88.5%; range, 80 to 92%) [p < 0.025]. The fraction of time spent in hypoxemia (ie, SaO(2) < 90%) was lower during PSG monitoring at home (40.8%; range, 5 to 100%) than during oximetry monitoring (59.9%; range, 6 to 100%) [p < 0.01]. Desaturation time (DeltaSaO(2) > 4%) was lower during PSG monitoring at home (22.1%; range, 3 to 63%) during PSG monitoring at home than during oximetry monitoring (50.4%; range, 4 to 91%) [p < 0.01]. A correction for actual sleep during PSG monitoring reduced the differences between PSG monitoring at home and oximetry monitoring, although a difference in the desaturation time remained (PSG monitoring at home, 31.9% [range, 2 to 75%]; oximetry monitoring, 50.4% [range, 4 to 91%]) [p = 0.041]. A comparison of sleep architectures for nights when PSG was being monitored showed a higher arousal index in the hospital than at home (PSG monitoring in the hospital, 5.6 arousals per hour [range, 2 to 16 arousals per hour]; PSG monitoring at home, 2.5 arousals per hour [range, 1 to 6 arousals per hour]) [p < 0.025], but no differences in SaO(2) levels were found between PSG monitoring at home and PSG monitoring in the hospital. CONCLUSION: The artifacts due to sleep-monitoring equipment may cause an underestimation of the degree of nocturnal hypoxemia in COPD patients. The addition of an unfamiliar environment causes more sleep disruption, but this does not affect nocturnal SaO(2) levels further.

Aged↗
PubMed2006

Self-monitoring of glucose in type 2 diabetes mellitus: a Bayesian meta-analysis of direct and indirect comparisons.

OBJECTIVE: To evaluate the relative effectiveness of interventions with self-monitoring blood glucose and self-monitoring of urine glucose, versus interventions without self-monitoring, in terms of HbA(1c) reductions in type 2 diabetes mellitus. METHODS: Thirteen published full reports on randomised controlled trials investigating the effects of self-monitoring glucose were identified by a systematic search of Medline, Embase, the Cochrane Library (1966-Nov 2005) and previous reviews. Three types of studies were included: self-monitoring of blood glucose versus no self-monitoring, self-monitoring of blood glucose versus self-monitoring of urine glucose and self-monitoring of blood glucose with regular feedback versus monitoring without feedback. The internal validity of studies was assessed systematically by two reviewers, using 13 criteria of a validated list. Results from the three types of studies were analysed simultaneously with a Bayesian metaanalysis of direct and indirect comparisons. RESULTS: Adjusted for baseline HbA(1c) level and internal validity, interventions with self-monitoring of blood glucose showed a reduction in HbA(1c) of 0.40 percentage-points (%) (95% credible interval [CrI] 0.07 to 0.70%) in comparison to interventions without self-monitoring. Regular feedback more than doubled the HbA(1c) reduction. Self-monitoring of urine glucose showed comparable results to interventions without self-monitoring (0.02% decrease in HbA(1c); 95% CrI -0.62 to 0.70%). There is a 88% probability that interventions with self-monitoring blood glucose are more effective than interventions with urine glucose monitoring (relative reduction in HbA(1c) is 0.38%, 95% CrI -0.30 to 1.00%). CONCLUSION: The randomized clinical trials performed to date provided positive results on the effectiveness of interventions with self-monitoring of blood glucose in type 2 diabetes mellitus. Regular medical feedback of the monitored HbA(1c) levels is important. Furthermore, self-monitoring of blood glucose is likely to be more effective than self-monitoring of urine glucose.

Bayes Theorem↗
PubMed2002

Placement of intracranial pressure monitors by non-neurosurgeons.

Maintaining adequate cerebral perfusion is important in the treatment of patients with closed head injury. Placement of an intracranial pressure (ICP) monitor is necessary to determine both ICP and the cerebral perfusion pressure and serves as a guide to the contemporary management of traumatic brain injury. Insertion of such monitoring devices historically has been performed by neurosurgeons, but others including general (trauma) surgeons have successfully inserted simple ICP monitors. The purpose of this study was to assess the efficacy of ICP monitor placement and to compare the complication rates for ICP monitor placement by general surgery residents, trauma surgeons, and staff neurosurgeons. We retrospectively reviewed the medical records of trauma patients with cerebral injury who required insertion of parenchymal ICP monitors from January 1994 to January 1999. Monitor placement was performed by staff neurosurgeons, general surgical residents, and trauma surgeons. Surgical residents received appropriate training in the placement of ICP monitors from attending trauma surgeons and neurosurgeons. Records were examined for demographic variables such as age, gender, mechanism of injury, admission Glasgow Coma Score, and Injury Severity Score. Records were also reviewed for duration of ICP monitoring and for complications (i.e., intracranial hemorrhage after monitor placement, monitor-related infection, monitor malfunction, and monitor displacement). One hundred fifty-seven monitors were placed in 146 patients with intracranial injury. Surgical residents placed 87 ICP monitors without neurosurgical or trauma attending surgeons at the bedside and 43 with immediate supervision by general surgeons or neurosurgeons. Neurosurgeons placed 26 monitors without the participation of residents, and an attending trauma surgeon placed one monitor without the involvement of a resident or a neurosurgeon. There were no major technical complications, no episodes of catheter-induced intracranial hemorrhage, and no infectious complications. These data suggest that simple ICP monitors may be inserted by non-neurosurgeons without significant problems or complications. The low complication rate associated with this procedure was similar for neurosurgeons and non-neurosurgeons. We believe that insertion of simple parenchymal ICP monitors should be considered a core skill for trauma surgeons and should be included in surgical residency training. Insertion of ICP monitors by non-neurosurgeons is a potential method of improving the care of patients with brain injury in geographic areas that are underserved by neurosurgeons.

Adolescent↗
PubMed2000

Frequency and impact of high-resolution monitor failure in a filmless imaging department.

The purpose of this study was to assess the image quality and the rate of failure of the high-resolution (2,048 x 1536 pixel) monitors used for primary diagnosis in a filmless radiology department and to analyze the type of problems encountered as well as the action taken to repair the monitors. Data were collected from Picture Archival and Communication System (PACS) service logs to determine rates of monitor adjustment and replacement, the symptoms reported, and the action taken. Additionally, random surveys of the high-resolution monitors were performed using a standard test pattern to assess spatial and contrast resolution in the center and outer corners of the monitors. Analysis of monitor service records showed a high rate of monitor replacement (41% per year) resulting in a relatively short "life expectancy" (defined as average time required before replacement) of 2.4 years. Random surveys of monitor quality using a standard test pattern showed suboptimal image quality in approximately 54% of the monitors with moderate image quality degradation present in at least one region of 27% of the high-resolution monitors, despite our vendor's quality control program. The results of this study support our subjective impression and those of other colleagues in the PACS community of an unacceptably high monitor failure rate and persistent image quality problems with 2,000 pixel monitors used for primary diagnosis. The relatively high incidence of suboptimal quality monitors suggests that more frequent quality control should be performed using a test pattern particularly given the fact that radiologists often are unable to discern degradation of monitor performance using clinical images. The high incidence of problems with image quality on high-resolution monitors indicates that vendors need to develop better quality control in monitor design and testing. Radiologists should review briefly a test pattern on each monitor at the beginning of each day. A computer program should be incorporated into the PACS, which asks radiologists to evaluate a test pattern and records the results in a central database, which is communicated to the service engineers. Further studies should be evaluated to determine the clinical impact of monitor image degradation, which is relatively easily seen using a test pattern but may be difficult to discern on clinical images. Requests for proposals (RFPs) for PACS and service contracts must specify carefully requirements for monitor image quality and conditions under which the vendor is required to replace these monitors.

Computer Terminals↗
PubMed2001

[Is measuring the depth of anesthesia sensible? An overview on the currently available monitoring systems].

Without any doubt there is an increasing need for accurately measuring depth of anesthesia - from the viewpoint of the anesthesiologist and also of the patient. The ideal monitoring should fulfill the following criteria: It should be applicable for any type of anesthesia (intravenous as well as inhalative anesthesia); the monitor must have an extremely high sensitivity (each patient being awake must be recognized by the device).If the monitor does not have a high sensitivity, the monitor itself might lead to an increasing number of patients being awake during anaesthesia, because the anesthesiologist might rely on the monitor and does not deepen anesthesia while the patient is awake. Specificity is not as important as sensitivity. As incidence of interoperative awareness is low, one must monitor more than 750 patients to recognize only one patient who is awake. Finally, the monitoring device must be economic. If costs are considerably increased by measuring depth of anesthesia in today's climate of cost consciousness, the monitoring has to be restricted to special high risk groups of patients. If monitoring depth of anesthesia will become simple, safe, and economic, each anesthesia should be monitored for its depth, as today each patient needs pulseoxymetry. We try to give an orientation about the available devices for monitoring depth of anesthesia. Since the introduction of BIS interest in measuring depth of anesthesia is growing very dynamically. Due to the dynamic growth we hope that we were able to present an actual and complete overview about the monitoring systems for measuring depth of anesthesia. Until today no monitoring system has proven to fulfill the mentioned criteria. Monitoring of the depth of anesthesia will be based on any processing of the spontaneous EEG or its evoked potentials. Which type of monitoring, entropy, BIS, PSI, or MLAEP will be used in clinical routine will be shown in the future. All available monitors are no predictors, whether depth of anesthesia is sufficient for the next painful surgical stimulus. They can only monitor the anesthetic state at the time of measurement. There is no "golden number" predicting absolutely safely that the patient is in adequate anesthesia. The anesthetist must consider any technique for monitoring of the depth of anesthesia as an additional help in improving care for his patient.

Anesthesia, General↗
PubMedDate not supplied

[Systolic blood pressures are not comparable when home blood pressure is measured with a wrist or an arm validated monitor].

OBJECTIVES: To compare home blood pressure values obtained with two validated OMRON (wrist or arm) monitors used sequentially in the same subject. METHODS: In 265 hypertensive subjects referred to hypertension specialists, a self measurement of blood pressure was performed sequentially with an OMRON M4-I (arm cuff, A/A, BHS validation) or OMRON RX-I (wrist cuff, B/B, BHS validation). Each patient recorded home blood pressure during two periods of 4 days with 3 measures in the morning and 3 in the evening. Order for use of each monitor was randomised. With wrist devices, subjects were advised to keep the arm at heart level during measurements. BP values were reported on a standardized document. Patients were asked by a questionnaire about the tolerance and feasibility of the 2 methods. RESULTS: In this population, aged 59 +/- 14 years, with 60% of men and a mean blood pressure of 152 +/- 21 / 86 +/- 14 mmHg, the home blood pressure values were 143 +/- 20/81 +/- 11 mmHg with the arm monitor and 135 +/- 10 / 80 +/- 11 mmHg with the wrist monitor. Mean SBP adjusted on age, initial blood pressure level and period order was significantly lower when home blood pressure monitoring has been recorded with a wrist monitor as compared to an arm monitor (p < 0.001). Self measurement of blood pressure was felt as easy in 92% with the arm monitor and in 96% with the wrist monitor (p < 0.05). Self measurement of blood pressure was felt as constraining in 14% with the arm monitor and in 7% with the wrist monitor (p < 0.01). The feasibility between the two devices was good with none of the value missing in 86% with the arm monitor and in 85% with the wrist monitor. The missing values were in 56% the fourth day. CONCLUSION: Despite the use of two validated monitors, mean SBP is significantly lower when home blood pressure monitoring is recorded with a wrist monitor as compared to an arm monitor. Uncertainty in the arm position with the use of wrist device could explain these results. When advising home blood pressure monitoring, care should be taken to recommend only the use of validated devices and to prefer the use of arm devices in order to avoid the uncertainty of an inadequate utilisation.

Adult↗
PubMed1999

Task force VI: Self-monitoring of the blood pressure.

BACKGROUND: Self-monitoring of the blood pressure by patients at home or in other nonclinical settings has become increasingly common in recent years. This phenomenon has been fueled in part by the increase in availability of automatic sphygmomanometers, which are now both affordable and easy for patients to use. BENEFITS OF SELF-MONITORING: Self-monitoring of the blood pressure can be an important adjunct to management of hypertension. The technique allows patients to participate more in their care. Self-measured values of blood pressure are more likely to be representative of the average daily blood pressure than is a clinic measurement and may be better related to hypertensive involvement of target organs and cardiovascular morbidity than is the clinic blood pressure. Finally, the self-monitoring of blood pressure has the potential to reduce the costs of hypertension-related care. LIMITATIONS OF SELF-MONITORING: There are several issues that prevent the more widespread use of self-monitoring of the blood pressure in clinical practice. First, devices marketed for use by patients have advanced technically during the 1990s, but many have not been subjected to rigorous clinical validation for precision and reliability (e.g. in terms of Association for the Advancement of Medical Instrumentation and British Hypertension Society guidelines). It is recommended that devices for measuring blood pressure used by patients at home be subjected to the same validation processes as those that are applied to ambulatory recordings. Second, although the upper limits of normal for self-monitored blood pressure of a general population can be defined statistically (it is approximately 135/85 mmHg), it is not yet possible to determine the normal self-monitored blood pressure because these values must be linked to classical clinical cardiovascular endpoints or outcomes. Third, the relationships among self-monitored, clinic, and ambulatory blood pressures are defined for some populations but their behaviors according to age, sex, ethnicity, and treatment status require further study. Fourth, several different schedules for self-monitoring of the blood pressure by patients have been used in clinical research and practice. It will be necessary to determine the optimal schedule and number of recordings required when patients perform self-monitoring of the blood pressure. Fifth, self-monitoring of the blood pressure in clinical trials of antihypertensive therapies is certainly feasible but has typically not been included in their design, either by investigators or by the pharmaceutical sponsors. Sixth, there have been data suggesting that self-monitoring of the blood pressure reduces the comprehensive costs associated with hypertension care on an annual basis. However, since most work on the economic impact of self-monitoring of the blood pressure has been performed in managed-care environments in the USA, it is not known whether this reduction in health-care costs would be applicable to other types of practice environments on a worldwide basis. CONCLUSIONS: Self-monitoring of the blood pressure is at present useful as an adjunct measurement for the management of hypertensive patients and might provide benefits in clinical trials of antihypertensive therapy. Nevertheless, the available data on self-monitoring of the blood pressure are inadequate as grounds for clinicians to make primary diagnostic or therapeutic decisions and should not override the blood pressure obtained by clinical measurement or via ambulatory monitoring.

Blood Pressure↗
PubMed2003

Detection of gaps in the spatial coverage of coral reef monitoring projects in the US Caribbean and Gulf of Mexico.

As part of the US Coral Reef Task Force's National Program to Map, Assess, Inventory, and Monitor US Coral Reef Ecosystems, a comprehensive survey of projects/programs monitoring coral reef ecosystems and related habitats (i.e., seagrass beds and mangroves) in the US Caribbean and Pacific was undertaken. Information was gathered on a total of 296 monitoring and assessment projects conducted since 1990 in the US Caribbean and the Gulf of Mexico. Substantial gaps in monitoring coverage of US coral reef ecosystems were revealed through geographic information system (GIS) analysis of survey metadata. Although southern Florida contains approximately two-thirds of all marine monitoring projects found in the US Caribbean and Gulf of Mexico, we were unable to identify any ongoing projects that monitor coral reefs along Florida's western coast and off of the Florida Middle Grounds. Additionally, Florida is covered by approximately 1 900 km2 of mangroves, yet there were only four ongoing projects that monitor this ecosystem, leaving gaps in coverage in the Lower and Middle Keys and along the eastern and western coasts. The Flower Garden Banks National Marine Sanctuary, located offshore of the Texas/Louisiana border, has an integral long-term monitoring program, but lacks a monitoring project that gathers long-term, quantitative data on reef lish abundance and certain water quality parameters. Numerous coral reef monitoring projects in Puerto Rico are concentrated on the island's southwestern coast surrounding La Parguera, while far fewer monitoring projects are conducted along the northern and southeastern coasts and around Vieques Island. In the US Virgin Islands, the paucity of monitoring projects in large areas of St. Croix and St. Thomas contrasts with monitoring activity in three marine protected areas (MPAs), where 66% of the US Virgin Islands' coral reef monitoring sites were found. Only a series of assessments have been conducted at Navassa, a small, uninhabited island located 55 km west of Haiti and 137 km northeast of Jamaica. In order to better understand changes in coral reef communities and to produce a series of biennial reports on the status of US coral reef ecosystems, the National Oceanic and Atmospheric Administration (NOAA) is developing a national coral reef monitoring network. This network has already begun to fill some of these gaps in monitoring coverage through issuing cooperative grants to states and territories to build long-term monitoring capacity.

Animals↗
PubMed2001

Quality-control issues on high-resolution diagnostic monitors.

Previous literature indicates a need for more data collection in the area of quality control of high-resolution diagnostic monitors. Throughout acceptance testing, which began in June 2000, stability of monitor calibration was analyzed. Although image quality on all monitors was found to be acceptable upon initial acceptance testing using VeriLUM software by Image Smiths, Inc (Germantown, MD), it was determined to be unacceptable during the clinical phase of acceptance testing. High-resolution monitors were evaluated for quality assurance on a weekly basis from installation through acceptance testing and beyond. During clinical utilization determination (CUD), monitor calibration was identified as a problem and the manufacturer returned and recalibrated all workstations. From that time through final acceptance testing, high-resolution monitor calibration and monitor failure rate remained a problem. The monitor vendor then returned to the site to address these areas. Monitor defocus was still noticeable and calibration checks were increased to three times per week. White and black level drift on medium-resolution monitors had been attributed to raster size settings. Measurements of white and black level at several different size settings were taken to determine the effect of size on white and black level settings. Black level remained steady with size change. White level appeared to increase by 2.0 cd/m2 for every 0.1 inches decrease in horizontal raster size. This was determined not to be the cause of the observed brightness drift. Frequency of calibration/testing is an issue in a clinical environment. The increased frequency required at our site cannot be sustained. The medical physics division cannot provide dedicated personnel to conduct the quality-assurance testing on all monitors at this interval due to other physics commitments throughout the hospital. Monitor access is also an issue due to radiologists' need to read images. Some workstations are in use 7 AM to 11 PM daily. An appropriate monitor calibration frequency must be established during acceptance testing to ensure unacceptable drift is not masked by excessive calibration frequency. Standards for acceptable black level and white level drift also need to be determined. The monitor vendor and hospital staff agree that currently, very small printed text is an acceptable method of determining monitor blur, however, a better method of determining monitor blur is being pursued. Although monitors may show acceptable quality during initial acceptance testing, they need to show sustained quality during the clinical acceptance-testing phase. Defocus, black level, and white level are image quality concerns, which need to be evaluated during the clinical phase of acceptance testing. Image quality deficiencies can have a negative impact on patient care and raise serious medical-legal concerns. The attention to quality control required of the hospital staff needs to be realistic and not have a significant impact on radiology workflow.

Calibration↗
PubMed2002

Monitoring flap for buried free tissue transfer: its importance and reliability.

To improve the success rate of microsurgical flap transfers into a buried area, it is important to monitor the circulation of the flap during the early stage. A monitoring flap includes such advantages as simplicity, reliability, noninvasiveness, and the ability to continuously monitor the vascular status of various buried flaps. This article describes experiences related to the importance and reliability of a monitoring flap. A total of 109 flaps in 99 patients were treated with buried free flaps, including a monitoring flap, between 1990 and 1999. Forty-nine patients received a tubed free radial forearm flap with a skin-monitoring flap, and six received a free jejunal flap with a jejunal segment monitoring flap for the reconstruction of the esophagus. Vascularized fibular grafts with a skin monitoring flap or peroneus longus muscle monitoring flap were used for reconstructing the mandible in six patients and for treating osteonecrosis of the femoral head in 48 flaps in 38 patients. Monitoring flap abnormalities were indicated in 14 flaps; therefore, immediate revisions were performed on the pedicle of the monitoring flap and microanastomosis site. Among these 14 flaps, nine showed true thrombosis and five showed false-positive thrombosis. Among the nine flaps that showed true thrombosis, five were salvaged and four were finally lost. The false-positive thrombosis in the five flaps was attributed to torsion or tension of the perforator of the monitoring flap in three flaps, an unclear determination in one flap because the monitoring flap size was too small, and damage to the perforator in the last flap. The total thrombosis rate was 8.3 percent (nine of 109), and the failure rate of the free tissue transfer was 3.7 percent (four of 109). The overall sensitivity of the monitoring flap was 100 percent, the predictive value of a positive test was 64 percent (nine of 14), and false-positive results occurred in 36 percent (five of 14). The salvage rate was 55.6 percent. To improve the reliability of a monitoring flap, it is recommended that the size of the flap be larger than 1 x 2 cm to assess the arterial status, and that a perforator with the appropriate caliber be selected. When a monitoring flap is fixed to a previous incision line or a newly created wound, any torsion or tension of the perforator should be avoided. In conclusion, the current results suggest that a monitoring flap is a simple, extremely useful, and reliable method for assessing the vascular status of a buried free flap.

Adolescent↗