A comparison of the Cook-Swartz Doppler with conventional clinical methods for free flap monitoring: A systematic review and a meta-analysis

Han, Zhaofeng; Guo, Lili; Linbo, Liu; Li, Qian; Zhou, Jian; Wei, Aizhou; Guo, Pengfei

doi:10.1016/j.ijsu.2016.06.034

Cited by 30 publications

(31 citation statements)

References 29 publications

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“…In general, vascular complications predominantly occur in the first 48 hours postsurgery and the flap salvage outcome within this period is superior to after this period . In the control group, only 1 case exhibited abnormal findings within the first 48 hours.…”

Section: Discussionmentioning

confidence: 96%

“…In case of an implantable Doppler, there are conflicting reports about its benefits in improving flap survival . A meta‐analysis determined that it can improve flap survival . However, it indicated that there was a greater frequency of false positives than with conventional monitoring .…”

Section: Discussionmentioning

confidence: 99%

“…6 Moreover, adjunctive monitoring methods are known to achieve optimal effectiveness when used in conjunction with clinical examination. 7 Therefore, clinical examination is an essential component of flap monitoring and remains the most commonly used and reliable method. [6][7][8][9][10][11] One commonly used method of reconstruction for large, subtotal scalp defects is the free latissimus dorsi muscle flap covered with skin graft.…”

Section: Introductionmentioning

confidence: 99%

“…7 Therefore, clinical examination is an essential component of flap monitoring and remains the most commonly used and reliable method. [6][7][8][9][10][11] One commonly used method of reconstruction for large, subtotal scalp defects is the free latissimus dorsi muscle flap covered with skin graft. [12][13][14][15][16] Unlike other myocutaneous flaps, this method results in less bulkiness and excellent contours.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

et al. 2018

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

et al. 2018

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“…However, implantable Doppler devices may dislodge, malfunction, or injure an anastomosis upon removal . Furthermore, an increase in false‐positive rates of vascular occlusion detection have been reported . Lastly, other emerging noninvasive modalities for measuring oxygen such as photoacoustic imaging and paint‐on bandages, though useful in the right situation, harbor inherent weaknesses.…”

Section: Discussionmentioning

confidence: 99%

Measuring Flap Oxygen Using Electron Paramagnetic Resonance Oximetry

et al. 2019

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Objectives/Hypothesis To determine if electron paramagnetic resonance (EPR) oximetry is a viable technology to aid in flap monitoring. Study Design Prospective cohort. Methods This was a cohort study assessing accuracy and speed of EPR oximetry in detecting ischemia of a saphenous artery–based flap in a rat model, using transcutaneous oximetry as a control. Measurements were obtained under both resting and ischemic conditions for nine Sprague Dawley rats (18 flaps), for 3 postoperative days following flap elevation. Results The mean partial pressure of oxygen prior to tourniquet application was 66.9 ± 8.9 mm Hg with EPR oximetry and 64.7 ± 5.2 mm Hg with transcutaneous oximetry (P = .45). Mean partial pressures of oxygen during tourniquet application were 8.9 ± 3.2 mm Hg and 8.5 ± 2.9 mm Hg for EPR oximetry and transcutaneous oximetry, respectively (P = .48), and 67.2 ± 6.9 mm Hg and 65.3 ± 6.1 mm Hg after tourniquet release for EPR oximetry and transcutaneous oximetry, respectively (P = .44). The mean ischemia detection time of EPR oximetry was 49 ± 21 seconds. Conclusions Offering timely, accurate, and noninvasive tissue oxygen measurements, EPR oximetry is a promising adjunct in flap monitoring. Level of Evidence NA Laryngoscope, 129:E415–E419, 2019

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Monitoring Vascular Compromise Using Ultrasound After Free Tissue Transfer

Shinomiya

Sunagawa

Nakashima

et al. 2019

J of Ultrasound Medicine

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Objectives-To report the clinical utility of high-resolution ultrasound (US) for monitoring vascular compromise after free tissue transfer.Methods-Fifty-two tissue transfers in the extremities were included in this study. Blood flow around the anastomotic pedicle and subcutaneous tissue of the grafted flap was monitored with pulsed color and power Doppler US whenever the conventional monitoring method, comprising the bedside assessment of the temperature, capillary refill, and flap color, showed abnormalities until 1 week after reconstruction.Results-All flaps were indicated for US monitoring, with 44 flaps showing Doppler signals in each position, even though conventional flap monitoring showed an abnormality. Forty of the 44 flaps showed no flap failure, whereas the remaining 4 flaps developed partial necrosis. Abnormal US findings were noted in 8 of the 52 flaps. Ultrasound revealed interruption of venous blood flow around the anastomotic pedicle in 6 of 8 flaps. Emergent exploration revealed venous occlusion at the anastomotic pedicle, similar to the US finding. In 2 of the 8 flaps, US showed no blood flow to either the anastomotic pedicle or subcutaneous tissue. Emergent exploration revealed arterial occlusion at the anastomotic pedicle. Seven of the 8 reexplored flaps were salvaged after revision surgery with complete flap survival. Partial flap survival was noted in 1 case, but complete flap failure was avoided.Conclusions-Ultrasound is a useful adjunct that enables a direct assessment of perfusion in grafted tissues, which may reduce unnecessary exploration when conventional flap monitoring shows an abnormality.

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A comparison of the Cook-Swartz Doppler with conventional clinical methods for free flap monitoring: A systematic review and a meta-analysis

Abstract: More studies are needed to evaluate if Cook-Swartz Doppler can be used alone, or to be better used as an adjunctive technique to complement the clinical method of monitoring.

Cited by 30 publications

References 29 publications

Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

Effectiveness of small monitoring skin paddle in free muscle flap for scalp reconstruction

Measuring Flap Oxygen Using Electron Paramagnetic Resonance Oximetry

Monitoring Vascular Compromise Using Ultrasound After Free Tissue Transfer

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