The role of the implantable Doppler probe in free flap surgery

Abstract

Objectives/hypothesis: Free tissue transfer has success rates greater than 95%. Approximately 10% will require reexploration for vascular compromise. Return to the operating room within 48 hours yields the highest rate of successful salvage. Our aim was to determine whether an implantable Doppler used for intraoperative/postoperative monitoring would 1) alter the pattern of detecting flap failure and 2) alter the overall incidence of flap survival.

Study design: Prospective analysis.

Methods: Generic and study specific data was collected. Note was made at the end of the case if revision of the vascular anastomosis was performed. Data was collected for flap outcomes in the postoperative period.

Results: A total of 1,236 free tissues transfers from 2001 through 2011 were analyzed. Ninety-four were outside the head and neck or the Doppler was not used/inadvertently discontinued. A total of 1,142 flaps make up the study cohort. One hundred thirty-four (11.7%) intraoperative flow problems were detected, all successfully revised. Of these, 15 (11%) required postoperative revision and five (33%) were successfully salvaged, with an overall survival 93%. A total of 1,008 flaps did not require intraoperative revision, 62 required reexploration (6.1%), and 38 (61%) were salvaged. The overall survival was 97.6%. There were eight false positive (no intervention) and 10 false negatives. Sensitivity was 87% with specificity 99%.

Conclusion: Intraoperative Doppler's increase the detection of immediate/incipient vascular problems. Patients requiring revision in the operating room require revision more often in the postoperative period (P = .03) and are less likely to have successful salvage and a lower flap survival rate (P = .05).

Keywords: Doppler; flap failure; flap salvage; free tissue transfer; intraoperative monitoring.