title: Color Doppler ultrasound: effective monitoring of the buried free flap in facial reanimation.
abstract: OBJECTIVE
  The gracilis muscle free flap has become a reliable means for smile reanimation for patients with facial paralysis. Because it is a buried flap, it presents a postoperative monitoring challenge. We sought to evaluate our experience with color Doppler ultrasound in the monitoring of gracilis free flap viability in the immediate postoperative setting.
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  Patients with facial paralysis treated with gracilis muscle free flap for smile reanimation performed between March 2009 and November 2010 were evaluated by color Doppler ultrasound and included in the study. Our experience with the use of the color Doppler ultrasound to monitor the gracilis muscle flap is presented.
  
  
  RESULTS
  Forty-six patients were identified. In all cases, color Doppler ultrasound was used postoperatively to assess flow through the vascular pedicle. Outcomes included an early flap survival rate of 100%, with no instances of equivocal or absent flow on either the arterial or venous side. Color Doppler ultrasound provided important objective information regarding muscle perfusion postoperatively in several instances of equivocal postoperative perfusion of the flap.
  
  
  CONCLUSIONS
  Color Doppler ultrasound is a safe, noninvasive method that can be performed serially to evaluate a buried free flap. We have had success in verifying normal arterial and venous flow through the pedicle using this method of monitoring of the gracilis muscle free flap during facial reanimation, and in 3 instances, it eliminated the need for wound exploration to verify appropriate muscle perfusion.
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Kalpesh T
authors.initials: KT
authors.lastname: Vakharia
authors.forename: Douglas
authors.initials: D
authors.lastname: Henstrom
authors.forename: Robin
authors.initials: R
authors.lastname: Lindsay
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Cunnane
authors.forename: Mack
authors.initials: M
authors.lastname: Cheney
authors.forename: Tessa
authors.initials: T
authors.lastname: Hadlock
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005158:Facial Paralysis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000637:transplantation; D011182:Postoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D012720:Severity of Illness Index; D012904:Smiling; D013524:Surgical Flaps; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult