The implantable Cook-Swartz Doppler probe for postoperative monitoring in head and neck free flap reconstruction.
OBJECTIVE
To determine if the implantable Cook-Swartz Doppler Flow Monitoring System (Cook Vascular Inc, Vandergrift, Pennsylvania) improves surgical salvage rates for compromised free flaps.


METHODS
Retrospective medical record review spanning 2002 to 2006 for a large head and neck oncology program.


METHODS
A tertiary care hospital.


METHODS
A consecutive series of 351 patients (244 men and 107 women; mean age, 58.63 years) who underwent free flap reconstruction of head and neck defects that were monitored using the implantable Doppler probe were included.


RESULTS
The most common indication for surgery was squamous cell carcinoma (81.0%), followed by functional reconstruction (4.3%). The most common free flap used was radial forearm (68.0%), followed by the fibular free flap (19.0%). With operative exploration used as the gold standard, the Cook-Swartz Doppler Flow Monitoring System had a sensitivity of 65.8% and specificity of 98.2% for the detection of flap compromise. For the detection of vascular compromise of the monitored vessel (excluding flap compromise cases whereby flow in the monitored vessel was not compromised on operative exploration, ie, venous obstruction, hematoma formation, and necrotizing fasciitis), the sensitivity increased to 100%.


CONCLUSIONS
This is the largest reported series, to our knowledge, of implantable Cook-Swartz Doppler use, and our experience would suggest that this is a reliable technique for postoperative monitoring in head and neck reconstruction. Our use of the implantable Doppler probe allowed us to recognize vascular compromise early, resulting in an overall flap success rate of 98.1%, with a 92.0% salvage rate of flaps that experienced vascular compromise of the monitored vessel.
Guillemaud
Jennifer P
JP
FRCSC, Division of Otolaryngology, Head and Neck Surgery, 1E4.29 Walter MacKenzie Health Science Centre, 8440 112th St, Edmonton, AB T6G 2R7, Canada. jeffreyharris@cha.ab.ca.
Seikaly
Hadi
H
Cote
David
D
Allen
Heather
H
Harris
Jeffrey R
JR
D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging*; D017078:Laser-Doppler Flowmetry / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000175:diagnosis*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013524:Surgical Flaps / Q000098:blood supply*; D014463:Ultrasonography
D011138:Polytetrafluoroethylene