The time to detection of vascular compromise and the postoperative time to reexploration are shorter using the implantable Doppler (ID) probe, thereby resulting in earlier surgical reexploration and a higher flap salvage rate.
Methods
A single-centre experience with 176 consecutive free flap reconstructions in 167 patients from 2000 to 2008 in a university-based teaching hospital by retrospective chart review is presented.
Results
There was a significant difference in overall flap survival (ID 98.0%, external Doppler [ED] 89.3%) and total flap loss (ID 2.0%, ED 10.7%) between the two groups (P=0.03). The difference in flap salvage rate was not significant (ID 90.9%, ED 63.6%; P=0.068). The false-positive (ID 0%, ED 3%; P=0.18) and false-negative rates (ID 0.0%, ED 4.5%; P=1.0) were not significantly different. There was also a lower median postoperative time to reexploration for the ID group, from 48 h to one week after initial surgery (ID 74.5 h, ED 136.8 h; P=0.05).
Conclusion
The present analysis revealed a potential benefit for the ID probe in the postoperative monitoring of free tissue transfers.
ChenKT, MardiniS., ChuangDC. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers.Plast Reconstr Surg2007; 120: 187–95.
3.
CusanoA., FernandesR.. Technology in microvascular surgery.Oral Maxillofac Surg Clin North Am2010; 22: 73–90.
SmitJM, AcostaR., ZeebregtsCJ, LissAG, AnnikoM., HartmanEH. Early reintervention of compromised free flaps improves success rate.Microsurgery2007; 27: 612–6.
6.
WhitakerIS, RozenWM, ChubbD.. Postoperative monitoring of free flaps in autologous breast reconstruction: A multicenter comparison of 398 flaps using clinical monitoring, microdialysis, and the implantable Doppler probe.J Reconstr Microsurg2010; 26: 409–16.
SchmulderA., GurE., ZaretskiA.. Eight-year experience of the Cook-Swartz Doppler in free-flap operations: Microsurgical and reexploration results with regard to a wide spectrum of surgeries.Microsurgery2011; 31: 1–6.
9.
SmitJM, ZeebregtsCJ, AcostaR., WerkerPM. Advancements in free flap monitoring in the last decade: A critical review.Plast Reconstr Surg2010; 125: 177–85.
10.
RosenbergJJ, FornageBD, ChevrayPM. Monitoring buried free flaps: Limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test.Plast Reconstr Surg2006; 118: 109–13.
11.
Abdel-GalilK., MitchellD.. Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: A systematic review of current techniques – part I. Non-invasive techniques.Br J Oral Maxillofac Surg2009; 47: 351–5.
12.
RozenWM, ChubbD., WhitakerIS, AcostaR.. The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps.Microsurgery2010; 30: 105–10.
13.
SelberJC, Angel Soto-MirandaM., LiuJ., RobbG.. The survival curve: Factors impacting the outcome of free flap take-backs.Plast Reconstr Surg2012; 130: 105–13.
14.
LohmanRF, LangevinCJ, BozkurtM., KunduN., DjohanR.. A prospective analysis of free flap monitoring techniques: Physical examination, external Doppler, implantable Doppler, and tissue oximetry.J Reconstr Microsurg2013; 29: 51–6.
15.
SiemionowM., ArslanE.. Ischemia/reperfusion injury: A review in relation to free tissue transfers.Microsurgery2004; 24: 468–75.
16.
BedriMI, ChangBW. Use of the implantable Doppler in free tissue breast reconstruction.Clin Plast Surg2011; 38: 309–12.
PoderTG, FortierPH. Implantable Doppler in monitoring free flaps: A cost-effectiveness analysis based on a systematic review of the literature.Eur Ann Otorhinolaryngol Head Neck Dis2013; 130: 79–85.
19.
RozenWM, AngGG, AcostaR., RahdonR.. Bedside maneuvers and waveform changes in the interpretation of the implantable Doppler probe signal for free-flap monitoring.Microsurgery2010; 30: 670–1.
20.
RozenWM, EnajatM., WhitakerIS, LindkvistU., AudolfssonT., AcostaR.. Postoperative monitoring of lower limb free flaps with the Cook-Swartz implantable Doppler probe: A clinical trial.Microsurgery2010; 30: 354–60.
21.
KindGM, BunticRF, BunckeGM, CooperTM, SikoPP, BunckeHJJr. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast Reconstr Surg1998; 101: 1268–73.
22.
PaydarKZ, HansenSL, ChangDS, HoffmanWY, LeonP.. Implantable venous Doppler monitoring in head and neck free flap reconstruction increases the salvage rate.Plast Reconstr Surg2010; 125: 1129–34.
23.
Abdel-GalilK., MitchellD.. Postoperative monitoring of microsurgical free-tissue transfers for head and neck reconstruction: A systematic review of current techniques – part II. Invasive techniques.Br J Oral Maxillofac Surg2009; 47: 438–42.
24.
BrownJS, DevineJC, MagennisP., SillifantP., RogersSN, VaughanED. Factors that influence the outcome of salvage in free tissue transfer.Br J Oral Maxillofac Surg2003; 41: 16–20.
25.
YapLH, ConstantinidesJ., ButlerCE. Venous thrombosis in coupled versus sutured microvascular anastomoses.Ann Plast Surg2006; 57: 666–9.
26.
SmitJM, KleinS., de JongEH, ZeebregtsCJ, de BockGH, WerkerPM. Value of the implantable doppler system in free flap monitoring.J Plast Reconstr Aesthet Surg2012; 65: 1276–7.
