- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02604069
Detection of Flap Ischemia Using Interstitial Glucose Monitor
Postoperative Monitoring of Tissue Perfusion in Microvascular Free Flaps Using Continuous Interstitial Glucose Monitoring Device: A Pilot Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background:
Breast reconstruction involving microvascular free tissue transfer is a major, labour-intensive operation that provides numerous benefits for patients' psychosocial function and well-being.
Flap failure, though rare, is a devastating complication and leads to serious morbidities. It can occur in the first 24-72 hours after the operation. However, if ischemia is detected earlier, the chances for operative salvage are better. Unfortunately, the current monitoring process remains mostly subjective.
A simple device that objectively assesses flap perfusion - either as a stand-alone tool or an adjunct to the current monitoring method - would be a tremendous improvement in detection of early postoperative flap ischemia and, in turn, increase flap salvage and survival.
Purpose:
The overall objective of this clinical pilot study is to examine the accuracy and reliability of measuring interstitial glucose levels using Continuous Glucose Monitoring (CGM) technology as an objective method of detecting postoperative flap tissue ischemia in patients undergoing free flap-based reconstructive surgery.
Methods:
In this pilot cohort study, the investigators aim to prospectively include 30 free flaps in total from 10-20 patients undergoing DIEP-based breast reconstruction by one surgeon at Juravinski Hospital. Patients will be recruited at the pre-operative consultation. The transcutaneous sensor of the CGM device will be inserted into the subcutaneous layer of the flap upon completion of surgery, while an additional sensor will be placed on the patient's thigh as control. These devices are blinded and will start recording the flap's interstitial glucose levels. The patient will be admitted and the flap will be assessed clinically as per protocol. On-call residents will be given a data collection sheet to document the exact time they were alerted about a flap, the clinical finding, and the subsequent decision made. Once an endpoint has been reached for a flap, the CGM sensor will be removed and its data extracted.
Data Analysis:
The timing of occurrence of low interstitial glucose levels and rapid glucose level decline will be analyzed with the timing of clinical concerns raised about the flap. The systemic glucose level will be used as a control for the flap glucose level. The investigators aim to analyze the temporal correlation between interstitial glucose measurements and clinical findings of the flap's vascular status (eg. vessel occlusion, ischemia). Statistical analysis will be done with assistance by a biostatistician.
Study Type
Enrollment (Anticipated)
Phase
- Early Phase 1
Contacts and Locations
Study Contact
- Name: Edward Liu, MD
- Email: Edward.Liu@medportal.ca
Study Locations
-
-
Ontario
-
Hamilton, Ontario, Canada, L8V 1C3
- Juravinski Hospital
-
Sub-Investigator:
- Matthew McRae, MD
-
Contact:
- Edward Liu, MD
- Email: Edward.Liu@medportal.ca
-
Sub-Investigator:
- Edward Liu, MD
-
Principal Investigator:
- Ronen Avram, MD
-
Sub-Investigator:
- Jiayi Hu, MD
-
Principal Investigator:
- Achilleas Thoma, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients who are undergoing unilateral or bilateral breast reconstruction with free flap including DIEP flaps at Hamilton Health Sciences, starting from the date of ethics approval.
Exclusion Criteria:
- Patients with diabetes (on oral antiglycemic medications or insulin-dependent)
- Patients who are on immunosuppressive medication
- Patients undergoing breast reconstruction involving expanders or implants
- Patients with active infections
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Continuous Glucose Monitor
Application of CGM for 6 days following free flap reconstruction in conjunction with clinical monitoring
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Temporal correlation between interstitial glucose measurements and flap ischemia
Time Frame: within 6 days after surgery
|
within 6 days after surgery
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidence of minor side effects related to device
Time Frame: within 6 days after surgery
|
within 6 days after surgery
|
Incidence of major adverse effects related to the device
Time Frame: within 6 days after surgery
|
within 6 days after surgery
|
Incidences of technical issues related to the device
Time Frame: within 6 days after surgery
|
within 6 days after surgery
|
Collaborators and Investigators
Investigators
- Principal Investigator: Ronen Avram, MD, Associate Professor, Plastic Surgery
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- CGM-2015-10
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Free Tissue Flaps
-
Rajiv Gandhi Cancer Institute & Research Center...Completed
-
Indiana UniversityTerminated
-
Asan Medical CenterCompletedFree Tissue FlapsKorea, Republic of
-
University of RegensburgUnknown
-
University of ChicagoCompletedHead and Neck Neoplasms | Free Tissue FlapsUnited States
-
Cairo UniversityCompletedReconstructed Jaws | Free Fibula Flaps | All on Four TechniqueEgypt
-
MMI SpaRecruitingOpen Surgery | Blood Vessels, Lymphatic Ducts and Nerves | Free FlapsSpain, Switzerland, Italy, Belgium, Austria, Germany
-
The University of Hong KongRecruitingDental Implant | Mandibular Reconstruction | Free Tissue Flaps | Jaw NeoplasmsHong Kong
-
Regina Elena Cancer InstituteCompletedMicrosurgical Free FlapsItaly
-
Boston Medical CenterWithdrawnFree Tissue Transfer | Mandible Reconstruction | Computerized CustomizationUnited States
Clinical Trials on Continuous Glucose Monitor
-
Yale UniversityMedtronicWithdrawn
-
University of NebraskaGreat Plains IDeA-CTREnrolling by invitationType 2 DiabetesUnited States
-
University of California, Los AngelesRecruitingPediatric ObesityUnited States
-
University of WashingtonDexCom, Inc.RecruitingGestational DiabetesUnited States
-
Yale UniversityNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Completed
-
Denver Health and Hospital AuthorityEnrolling by invitationAvoidant Restrictive Food Intake Disorder | Anorexia Nervosa, Binge Eating/Purging Type | ARFID | Anorexia Nervosa Restricting TypeUnited States
-
University of VirginiaDexCom, Inc.CompletedDiabetes Mellitus, Type 2 | Diabetes | Diabetes Mellitus, Type 1United States
-
HealthPartners InstituteThe Leona M. and Harry B. Helmsley Charitable TrustCompletedType 1 DiabetesUnited States
-
Woman'sDexCom, Inc.Active, not recruitingGestational Diabetes Mellitus in PregnancyUnited States
-
University of South FloridaCompletedMetabolic SyndromeUnited States