Advances in free flap monitoring: have we gone too far?
OBJECTIVE
Timely recognition of vascular compromise of free flaps is crucial to salvaging failing flaps. This review summarizes the most recent available literature about free flap monitoring over the period of 2008-2009. Novel techniques are discussed.


RESULTS
Several case series have been published that highlight interesting methods for free flap monitoring; however, concerns of impracticality abound. The implantable Doppler has been used in a large case series with good success. Externalization of a flap component has undergone refinement in technique with success. Measurement of tissue oxygen tension and blood flow with PET is possible. Microendoscopy has been proposed as a possible technique for accessible flaps to assess capillary blood flow. Several retrospective studies elucidated trends in free flap compromise in the postoperative period, which confirm prior findings.


CONCLUSIONS
We provide an overview of recent techniques for free flap monitoring. No single technique provides an ideal method for free flap monitoring, but these methods may prove promising with future research and refinement. New techniques in free flap monitoring largely remain out of the scope of reasonable implementation.
Luu
Quang
Q
University of California-Davis, Department of Otolaryngology, Sacramento, CA 95817, USA. Quang.luu@ucdmc.ucdavis.edu
Farwell
D Gregory
DG
D005260:Female; D005544:Forecasting; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000639:trends*; D010101:Oxygen Consumption / Q000502:physiology; D010808:Physical Examination / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D013524:Surgical Flaps / Q000098:blood supply*