A critical evaluation of the concomitant use of the implantable Doppler probe and the Vacuum Assisted Closure system in free tissue transfer

Abstract

Introduction of the Vacuum-Assisted Closure (V.A.C.) system has revolutionized the approach to a multitude of clinical settings. Yet, its use precludes adequate clinical monitoring of skin-grafted free flaps, thus, making a reliable monitoring system essential if broad clinical application is aspired. In a clinical study, the usefulness of the combination of the V.A.C. and implantable Doppler probe was critically evaluated in patients with microsurgical lower extremity reconstruction. We retrospectively analyzed the usefulness of the implantable Doppler probe in five consecutive patients treated in our department from January to July 2007. Inclusion criteria were lower extremity reconstruction by means of skin-grafted free tissue transfers with subsequent application of the V.A.C. device. Five consecutive patients (four males, one female) with a mean age of 37.8 years (range, 8-58 years) matched the criteria mentioned above. Of note, the two pediatric patients (8-year-old male and 12-year-old female) suffered from significant posttraumatic stress disorder necessitating concomitant psychological care by the Department of Psychiatry. All flaps healed uneventfully displaying no signs of vascular compromise. Interpretation of the Doppler signal was simple and well received by the nursing staff. The combination of V.A.C. and the implantable Doppler probe enhances patient comfort due to a reduction of the number of dressing changes while still allowing continuous free flap monitoring. Interpretation of the signal transmitted by the probe is simple and potentially reduces misinterpretations due to different levels of experience.

Clinical Efficacy and Safety of Negative-Pressure Wound Therapy on Flaps: A Systematic Review

“…1). [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] There was only one prospective randomized trial 27 ; the other 15 studies were all retrospective observational studies with low-level evidence according to the Oxford classification of evidence-based medicine (►Table 1). The first article on this topic was published in 2004, 31 and the remaining articles were published within the past 10 years (►Table 1).…”

“…According to the reconstruction maneuver, there were 18 (13.1%) local random flaps, 21,22 21 (15.3%) pedicle flaps, 29,[31][32][33]36 and 98 (71.5%) free flaps. [23][24][25][26][27][28]30,[32][33][34][35] However, the articles were divided into groups based on the purpose of NPWT application. The details are presented in ►Tables 2 to 5.…”

Advancements in Free Flap Monitoring in the Last Decade: A Critical Review

“…[23][24][25][26][27] Difficulty in the interpretation of back and forth motion of blood in the internal mammary vein, however, may occur. This can be tested by listening if the signal stops after clamping the vein.…”

Salvage Procedures After Failed Facial Reanimation Surgery Using the Masseteric Nerve as the Motor Nerve for Free Functional Gracilis Muscle Transfer

“…The facial artery and vein were used as recipient vessels ( Figure 1A), and patency of the anastomosis was monitored after microanastomosis by an implantable Doppler probe attached to the draining vein. 7,8 Doppler signal was normal in all patients, and the implantable Doppler probe was removed on the seventh postoperative day without complications. Six months after this second complicationfree procedure, no muscle excursion was observed, or the resulting muscle contraction was too weak to generate a symmetrical smile.…”