title: Postoperative monitoring of lower limb free flaps with the Cook-Swartz implantable Doppler probe: A clinical trial.
abstract: BACKGROUND
  Free flaps to the lower limb have inherently high venous pressures, potentially impairing flap viability, which may lead to limb amputation if flap failure ensues. Adequate monitoring of flap perfusion is thus essential, with timely detection of flap compromise able to potentiate flap salvage. While clinical monitoring has been popularized, recent use of the implantable Doppler probe has been used with success in other free flap settings.
  
  
  METHODS
  A comparative study of 40 consecutive patients undergoing microvascular free flap reconstruction of lower limb defects was undertaken, with postoperative monitoring achieved with either clinical monitoring alone or the use of the Cook-Swartz implantable Doppler probe.
  
  
  RESULTS
  The use of the implantable Doppler probe was associated with salvage of 2/2 compromised flaps compared to salvage of 2/5 compromised flaps in the group undergoing clinical monitoring alone (salvage rate 100% vs. 40%, P = 0.28). While not statistically significant, this was a strong trend toward an improved flap salvage rate with the use of the implantable Doppler probe. There were no false positives or negatives in either group. One flap loss in the clinically monitored group resulted in limb amputation (the only amputation in the cohort).
  
  
  CONCLUSIONS
  A trend toward early detection and salvage of flaps with anastomotic insufficiency was seen with the use of the Cook-Swartz implantable Doppler probe. These findings suggest a possible benefit of this technique as a stand-alone or adjunctive tool in the clinical monitoring of free flaps, with further investigation warranted into the broader application of these devices.
authors.affiliation: Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy, University of Melbourne, Grattan St, Parville, 3050, Victoria, Australia.
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Morteza
authors.initials: M
authors.lastname: Enajat
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Ulrica
authors.initials: U
authors.lastname: Lindkvist
authors.forename: Thorir
authors.initials: T
authors.lastname: Audolfsson
authors.forename: Rafael
authors.initials: R
authors.lastname: Acosta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D007223:Infant; D007869:Leg Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000295:instrumentation*; D018084:Ultrasonography, Interventional / Q000295:instrumentation*; D055815:Young Adult