title: Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region.
abstract: BACKGROUND
  Multiple perfusion assessment technologies exist to identify compromised microvascular free flaps. The effectiveness, operability, and cost of each technology vary. The authors investigated surgeon preference and clinical behavior with several perfusion assessment technologies.
  
  
  METHODS
  A questionnaire was sent to members of the American Society for Reconstructive Microsurgery concerning perceptions and frequency of use of several technologies in varied clinical situations. Demographic information was also collected. Adjusted odds ratios were calculated using multinomial logistic regression accounting for clustering of similar practices within institutions/regions.
  
  
  RESULTS
  The questionnaire was completed by 157 of 389 participants (40.4 percent response rate). Handheld Doppler was the most commonly preferred free flap-monitoring technology (56.1 percent), followed by implantable Doppler (22.9 percent) and cutaneous tissue oximetry (16.6 percent). Surgeons were significantly more likely to opt for immediate take-back to the operating room when presented with a concerning tissue oximetry readout compared with a concerning handheld Doppler signal (OR, 2.82; p < 0.01), whereas other technologies did not significantly alter postoperative management more than simple handheld Doppler. Clinical decision making did not significantly differ by demographics, training, or practice setup.
  
  
  CONCLUSIONS
  Although most surgeons still prefer to use standard handheld Doppler for free flap assessment, respondents were significantly more likely to opt for immediate return to the operating room for a concerning tissue oximetry reading than an abnormal Doppler signal. This suggests that tissue oximetry may have the greatest impact on clinical decision making in the postoperative period.
authors.affiliation: Baltimore, Md.; and New York, N.Y. From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; and the Department of Plastic and Reconstructive Surgery, New York University School of Medicine.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Bellamy
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: José M
authors.initials: JM
authors.lastname: Flores
authors.forename: Eric G
authors.initials: EG
authors.lastname: Wimmers
authors.forename: Georgia C
authors.initials: GC
authors.lastname: Yalanis
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
authors.forename: Justin M
authors.initials: JM
authors.lastname: Sacks
mesh_terms: D000328:Adult; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012955:Societies, Medical; D011795:Surveys and Questionnaires