The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps.
BACKGROUND
An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone.


METHODS
A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook-Swartz implantable Doppler probe. Outcome measures included flap salvage rate and false-positive rate.


RESULTS
There was a strong trend toward improved salvage rates with the implantable Doppler probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta-analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false-positive rates.


CONCLUSIONS
Flap monitoring with the implantable Doppler probe can improve flap salvage rates without increasing the rate of false-positive takebacks.
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy, University of Melbourne, Parkville 3050, Victoria, Australia. warrenrozen@hotmail.com
Warren M
WM
Rozen
Daniel
D
Chubb
Iain S
IS
Whitaker
Rafael
R
Acosta
D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008866:Microsurgery; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014159:Transducers; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000295:instrumentation*