title: Current evidence for postoperative monitoring of microvascular free flaps: a systematic review.
abstract: BACKGROUND
  Despite a plethora of monitoring techniques reported in the literature, only a small number of studies directly address clinical relevant end points, such as the flap salvage rate and false-positive rate.
  
  
  METHODS
  We conducted a systematic review of current evidence regarding the postoperative monitoring of microvascular free-tissue transfer via extensive electronic and manual search and perusing databases, such as PubMed, Cochrane, American College of Physicians (ACP) Journal Club, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and Ovid MEDLINE. The included literature (n = 184 publications) was critically appraised using March 2009 Oxford Centre for Evidence-Based Medicine definitions, focusing on the evidence for the efficacy of each technique in improving the flap salvage rate of compromised flaps.
  
  
  RESULTS
  There is a paucity of outcome-based studies, with only implanted Doppler probes, near-infrared spectroscopy, laser Doppler flowmetry, quantitative fluorimetry, and digital photography assessment using smartphones having been demonstrated in comparative studies to improve flap salvage rate. Currently, the implantable Doppler probe is the technique with the largest number of comparative studies and case series to demonstrate its effectiveness compared with clinical monitoring.
  
  
  CONCLUSIONS
  Future studies need to evaluate the most promising monitoring techniques further with a focus on assessing clinically relevant outcomes, such as the flap salvage rate and the false-positive rate, and not simple clinical series reporting patient and physician satisfaction.
authors.affiliation: From the *Monash Plastic Surgery Research Group, Peninsula Campus, Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston Victoria, Australia; †Department of Plastic and Reconstructive Surgery, Institute of Life Sciences, Swansea University College of Medicine, Reconstructive Surgery and Regenerative Medicine Research Unit, Swansea, United Kingdom; ‡Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy, University of Melbourne, Victoria, Australia; and §Joseph M. Still Burn and Reconstructive Surgery Center, Jackson, MS.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Chae
authors.forename: Warren Matthew
authors.initials: WM
authors.lastname: Rozen
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Daniel
authors.initials: D
authors.lastname: Chubb
authors.forename: Damien
authors.initials: D
authors.lastname: Grinsell
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ashton
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter-Smith
authors.forename: William C
authors.initials: WC
authors.lastname: Lineaweaver
mesh_terms: D001831:Body Temperature; D005470:Fluorometry; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D006801:Humans; D017551:Microdialysis; D063731:Mobile Applications; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry; D010781:Photography; D017156:Photoplethysmography; D011182:Postoperative Care / Q000379:methods*; D019265:Spectroscopy, Near-Infrared; D018608:Ultrasonography, Doppler