Implantable Cook-Swartz Doppler probe versus Synovis Flow Coupler for the post-operative monitoring of free flap breast reconstruction.
BACKGROUND
The Cook-Swartz Doppler has long been a trusted tool for close monitoring of blood flow after microvascular reconstruction; however, device implantation requires additional operating time. Synovis Life Technologies, Inc. received FDA approval in 2010 for the Flow Coupler, which combines an end-to-end anastomotic coupler with a removable 20 MHz Doppler, allowing both procedures to be performed simultaneously. However, its short history of widespread use necessitates further evaluation in the clinical setting. The authors studied the Synovis Flow Coupler in comparison to the more well-established Cook-Swartz Doppler for effectiveness and reliability in detection of vascular compromise.


METHODS
The authors reviewed 220 free flap breast reconstructions in 150 patients over a three-year period in which either the Cook-Swartz Doppler or the Synovis Flow Coupler was implanted to monitor blood flow. Outcomes measured include false-positive or false-negative rates (FPR, FNR); rates of OR take-back and salvage; and flap survival.


RESULTS
FPR was 1.0% for the Cook-Swartz Doppler and 1.9% for the Synovis Flow Coupler (p>0.05). FNR was 0.0% for both groups. Take-back rates were 10.1% for the Cook-Swartz, and 4.5% for Synovis (p>0.05). Flap failure rates were 1.8% and 0.9% for the Cook-Swartz and Synovis devices, respectively (p>0.05).


CONCLUSIONS
Our study reveals no statistically significant differences in outcomes for free flap breast reconstruction where either the Cook-Swartz Doppler or the Synovis Flow Coupler was used to monitor blood flow to the perforator flap.


METHODS
III.
Washington University School of Medicine, St. Louis, MO, USA.
Grace T
GT
Um
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Jeff
J
Chang
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Otway
O
Louie
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Shannon M
SM
Colohan
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Hakim K
HK
Said
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Peter C
PC
Neligan
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: dwmathes@uw.edu.
David W
DW
Mathes
D000714:Anastomosis, Surgical / Q000295:instrumentation; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000502:physiology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000295:instrumentation*; D016462:Mammaplasty; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation; D061525:Perforator Flap / Q000098:blood supply* / Q000502:physiology; D011184:Postoperative Period; D019736:Prostheses and Implants; D012039:Regional Blood Flow; D012189:Retrospective Studies
Breast reconstruction; Implantable Doppler; Microvascular anastomosis; Monitoring; Venous coupler