Outcomes and reliability of the flow coupler in postoperative monitoring of head and neck free flaps

Fujiwara, Rance J T; Dibble, Jacqueline; Larson, Scott V.; Pierce, Matthew L.; Mehra, Saral

doi:10.1002/lary.26944

Cited by 19 publications

(24 citation statements)

References 20 publications

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“…We find venous Doppler monitoring systems as an easy and reliable method of flap monitoring as has been demonstrated in head and neck 70 and breast free flaps, 71 with a sensitivity of 100% but high false positive rates of up to 13.6%. Most units will have their preferred methods of monitoring depending on local experience.…”

Section: Principles Of Surgical Treatmentmentioning

confidence: 74%

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Chan

Ferguson

Scarborough

et al. 2019

Indian J Plast Surg

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Osteomyelitis (OM) of the lower limb represents a large unmet global healthcare burden. It often arises from a contiguous focus of infection and is a recognized complication of open fractures or their surgical treatment, arthroplasty, and diabetic foot ulcers. Historically, this debilitating condition is associated with high rates of recurrence and secondary amputation. However, excellent long-term outcomes are now achieved by adopting a multidisciplinary approach with meticulous surgical debridement, skeletal and soft tissue reconstruction, and tailored antimicrobial treatment. This review focuses on the modern evidence-based management of post-traumatic OM in the lower limb from a reconstructive plastic surgery perspective, highlighting the latest developments and areas of controversy.

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Section: Principles Of Surgical Treatmentmentioning

confidence: 74%

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Chan

Ferguson

Scarborough

et al. 2019

Indian J Plast Surg

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“…As previously reported, venous coupler monitoring has high sensitivity for vascular compromise. 33,34 However, two metaanalyses report a false-positive Doppler signal loss incidence of 0 to 33% resulting in unnecessary surgical re-exploration. 9,35 Arterial monitoring may reduce the risk of a false-positive by 74% compared with venous monitoring; 35 unfortunately, deciphering venous and arterial monitoring incidence in this database was not possible.…”

Section: Journal Of Reconstructive Microsurgerymentioning

confidence: 99%

Adverse Events Associated with Implantable Dopplers during Microvascular Surgery

Pier

Pasick

Benito

et al. 2020

J Reconstr Microsurg

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Background Implantable Dopplers (IDs) are widely used for postoperative free flap vascular monitoring. However, IDs may contribute to free flap complications or failure and better understanding of device malfunctions is needed. Methods The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for all reports of ID adverse events from two leading manufacturers (Cook Vascular and Synovis Life Technologies) in free flap surgery from January 2010 to March 2020. Reports were reviewed and categorized. A comparison of reoperations within select categories was performed using Chi-square analysis. Results Of 209 included reports, the most common device malfunctions were venous anastomotic coupler misalignment (35.4%) and coupler ring detachment (24.4%). Synovis devices were used in 100% of reports of vessel compression and Cook Vascular devices were used in 77.7% of reports of probe detachment. Of 74 patient-related adverse events, the most common were reoperation (47.3%) and vessel occlusion (28.4%). Of five reported events of flap failure, two were associated with loss of ID signal. The proportion of Doppler signal loss events leading to reoperation was significantly greater than the proportion of any other Doppler-related event leading to reoperation. Intraoperative coupler replacement was the most commonly reported intervention (n = 86), and venous anastomosis with hand-suturing occurred in 30 device malfunctions. Conclusion This study demonstrates a variety of ID-related malfunctions. One-third of device malfunctions were associated with patient complications, and false-positive Doppler signal loss contributed substantially to the requirement of surgical re-exploration. These are important considerations for surgical teams utilizing IDs in free tissue transfer procedures.

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“…Implantable systems offer continuous evaluation of the blood flow, but require a second procedure to remove the implanted probe. [61][62][63][64][65] Using laser to assess microcirculation in the skin A laser is a device that generates an intense beam of coherent monochromatic light (or other electromagnetic radiation) by stimulated emission of photons from excited atoms or molecules.…”

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confidence: 99%

Laser Speckle Contrast Imaging in Reconstructive Surgery

Zötterman

2020

Linköping University Medical Dissertations

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Outcomes and reliability of the flow coupler in postoperative monitoring of head and neck free flaps

Abstract: 4. Laryngoscope, 128:812-817, 2018.

Cited by 19 publications

References 20 publications

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Management of Post-Traumatic Osteomyelitis in the Lower Limb: Current State of the Art

Adverse Events Associated with Implantable Dopplers during Microvascular Surgery

Laser Speckle Contrast Imaging in Reconstructive Surgery

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