title: Eight-year experience of the Cook-Swartz Doppler in free-flap operations: microsurgical and reexploration results with regard to a wide spectrum of surgeries.
abstract: BACKGROUND
  Microvascular free flap has become an increasingly popular useful method of reconstruction over the past few decades. Minimizing failure rates in these operations is a primary goal in every microsurgical unit that can be accomplished by early recognition.
  
  
  METHODS
  In this retrospective study, we tracked the admission of the implantable Doppler in the microsurgical unit (2000-2007) and evaluated parameters measured from 473 consecutive patients who underwent a total of 548 microsurgical procedures (489 primary surgeries and 59 reexplorations). The effectiveness of the Cook-Swartz Doppler (Cook Medical®) was examined in juxtapose general and subspecialty's aspects: in each microsurgical subspecialty, we compared the overall success and failure rates of the group with the implantable Doppler (n = 259) with the control group monitored by clinical means (n = 289). We also examined the duration, outcomes, and the effectiveness of this device in reexploration operations.
  
  
  RESULTS
  Overall, success rates were improved by using the implantable Doppler contrary to clinical assessment (96.14% vs. 89.27%) with a statistical significant (P < 0.005). The device was most effective in ENT (94.6% vs. 84%), breast reconstructive surgeries (97.3% vs. 82.36%), and orthopedic oncology (97.37% vs. 83.72%), whereas with reanimation operations and trauma/orthopedics subspecialties, it showed no necessity. In neurosurgery and in other/esthetic surgeries, the study was too small to draw definite deductions.
  
  
  CONCLUSIONS
  We recommend the usage of the implantable Doppler probe as an effective monitoring system for free-flap surgeries, with emphasis on subspecialties where the device demonstrated better results than traditional monitoring methods.
authors.affiliation: Plastic Surgery, Hand Surgery-Burn Center, RWTH University Hospital, Aachen, Germany. a.schmulder@yahoo.com
authors.forename: Ariel
authors.initials: A
authors.lastname: Schmulder
authors.forename: Eyal
authors.initials: E
authors.lastname: Gur
authors.forename: Arik
authors.initials: A
authors.lastname: Zaretski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D018608:Ultrasonography, Doppler; D055815:Young Adult