**Author details**

decreases wound tension. Tissue that is unnecessary for reconstruction and is supplied by the

There are a number of adjunctive monitoring devices that can be used to assess the adequacy of tissue perfusion. An electromagnetic flowmeter determines the absolute blood flow in a vessel by electromagnetic induction and allows immediate and continuous readings to see slow or rapid changes. The ultrasonic Doppler flowmeter has been in clinical use for more than 30 years and is useful if one is certain that the flow signal heard is from the vascular pedicle. Arterial thermometry is a system that measures temperature difference across a vascular anastomosis with implanted thermocouple probes. Fluorescein has been used to identify flaps with inadequate perfusion; when injected intravenously, it diffuses out to the capillaries into the interstitial fluid. The staining can then be visualized under ultraviolet illumination. The more intense the staining, the better the perfusion, and vice versa. The dermofluorometer enables the clinician to quantify minute degrees of fluorescence and uses smaller doses of the drug to prevent allergic reactions. Radioisotope washout of xenon 133, sodium pertechnetate Tc99m, iodine 131, and sodium 24 has been used to indicate the adequacy of perfusion; after administration of an isotope, clearance from the flap is monitored and correlated with flap perfusion (i.e., greater clearance equals greater flap perfusion). Pulse oximetery can detect pulsatile blood flow until the artery is 95% occluded. Laser-Doppler velocimetry is currently the best tool for objective monitoring of flaps. It must be in place when the flap is known to have good perfusion, because changes in this initial value are the important parameter. The laser-Doppler velocimeter can provide an accurate, easily interpretable readout of tissue perfusion that is rapidly responsive to changes in perfusion. Duplex Doppler ultrasonography is capable of identifying and characterizing blood flow from small, superficially located vessels, similar to those involved with microvascular surgery. Different shades of gray are assigned to stationary areas, whereas color is assigned to areas of motion such as blood flowing within a vessel. Vessels as small as 1 mm in diameter can be identified. Transcutaneous oxygen monitoring is also an option, where Po2 is measured directly to assess the state of microcir‐ culation. Finally, changes in interstitial fluid hydrostatic pressures can reflect changes in blood flow [175]. Radiologic literature on bone graft evaluation is sparse. Follow-up assessment of skeletal reconstruction with plain radiographs and cephalometric studies in the immediate postoperative period is needed to document the position of bone segments and the location of hardware. However, data on the evaluation of primary bone tumors and bone allografts stress the role of plain film radiography. In 1992, Soderholm and colleague [176] studied the effectiveness of using plain film radiography in the follow-up and prognosis of non-vascular bone grafting used in mandibular reconstruction. They concluded that narrow-beam radiog‐ raphy and spiral tomography are excellent tools for the evaluation of bone resorption and bony healing of mandibular grafts. Panoramic radiographs are able to visualize the whole mandib‐ ular bone and are used for a general assessment; tomography is used for specified, selected diagnostic tasks, such as to visualize bone resorption within the graft and under the plate. After reconstruction of large defects in the oral cavity or the oropharynx with myocutaneous or free microvascular flaps, physical rehabilitation by a therapist trained in speech and swallowing is of paramount importance, as these reconstructive procedures cannot fully restore the patient's ability to masticate, swallow, or speak. The major aims of physical therapy

vascular pedicle can be externalized and observed for impairment of blood supply.

700 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

Ata Garajei1,2,3\*, Ali Arabkheradmand2 , Mohammad Hosein Kalantar Motamedi4,5, Alex E. Pazoki6 and Ashkan Rashad7

\*Address all correspondence to: atagarajei@tums.ac.ir

1 Department of Oral and Maxillofacial Surgery, School of Dentistry, The Cancer Institute, Tehran

2 Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, Tehran, Iran

3 Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran

4 Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

5 Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences, Den‐ tal College, Tehran, Iran

6 Department of Oral and Maxillofacial Surgery, Johns Hopkins University, Baltimore, USA

7 Department of Oral and Maxillofacial Surgery, Bremerhaven Hospital (Reinkenheide); Bremerhaven, Germany
