title: What Are the Optimal Monitoring Techniques in Head and Neck Microvascular Reconstruction?
abstract: OBJECTIVE
  We evaluated the outcomes for widely used systems in terms of accuracy, salvage rates, and added cost compared to conventional monitoring.
  
  
  METHODS
  We performed a narrative review of the literature (high-impact report).
  
  
  RESULTS
  The overall free flap success for head and neck reconstruction is at least 95% using any type of monitoring. Salvage rates in decreasing frequency of monitoring techniques are 85% with near-infrared spectroscopy (NIRS), 81% with implantable Doppler, and 61.5% with conventional monitoring. False-positive rates in increasing frequency are 0% for NIRS, 0.4% for conventional monitoring, and <10% for implantable Doppler. Current data show implantable Doppler to be potentially cost-effective for institutions with a failure rate of at least 6%. Buried flaps may be monitored with conventional monitoring using an exteriorized paddle, or using implantable Doppler.
  
  
  CONCLUSIONS
  The cost-effectiveness of advanced flap monitoring systems beyond conventional monitoring is related to the success rate of each institution. Cost-effectiveness studies are necessary to determine at what point NIRS becomes advantageous.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, N.Y., USA.
authors.forename: Sami P
authors.initials: SP
authors.lastname: Moubayed
authors.forename: Moustafa
authors.initials: M
authors.lastname: Mourad
authors.forename: Mark L
authors.initials: ML
authors.lastname: Urken
mesh_terms: D006257:Head / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000601:surgery*; D008991:Monitoring, Physiologic; D009333:Neck / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D019651:Plastic Surgery Procedures; D019265:Spectroscopy, Near-Infrared; D013524:Surgical Flaps / Q000098:blood supply*; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures