Postoperative monitoring of lower limb free flaps with the Cook–Swartz implantable Doppler probe: A clinical trial

Rozen, Warren M.; Enajat, Morteza; Whitaker, Iain S.; Lindkvist, Ulrica; Audolfsson, Thorir; Acosta, Rafael

doi:10.1002/micr.20720

Cited by 35 publications

(51 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this series of 592 flaps, we excluded demographic data because numerous reports in the literature show that smoking, age, BMI, history of cardiovascular disease, diabetes and previous irradiation of the recipient site have no significant effect on flap failure rates [24][25][26][27]. During this study, our experience with other flap monitoring techniques was limited and when used, they were of limited effectiveness.…”

Section: Discussionmentioning

confidence: 94%

Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

2015

View full text Add to dashboard Cite

Background Monitoring the microcirculation postoperatively has been the subject of numerous original articles and reviews since the early 1980s. Effective monitoring returns compromised flaps to the operating room early, increases the flap success and reduces secondary complications. We would like to present the case based on our experiences that clinical monitoring alone is sufficient for the majority of patients. Methods Using a retrospective case note review, we present the experiences of the senior surgeon (DG) in his first 592 consecutive free tissue transfers in practice. Results The overall success rate was 98.9 % (585/592) with an overall salvage rate of 93 % (13/14).Conclusions Clinical monitoring provides sufficient reassurance in the majority of patients undergoing free tissue transfers. We believe that buried flaps and flaps to the lower limb may warrant adjunctive monitoring techniques on a case-by-case basis. Level of Evidence: Level IV, diagnostic study.

show abstract

Section: Discussionmentioning

confidence: 94%

Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

2015

View full text Add to dashboard Cite

show abstract

“…A tailored latissimus dorsi musculocutaneous flap is harvested with subsequent microsurgical anastomosis to the target vessel with preferential end-to-side anastomosis of the artery and end-to-end anastomosis of one or two veins. [18,29,30], die nicht-invasive kombinierte Laser-Doppler-Spektrophotometrie [16,36] oder auch die konfokale Lasermikroskopie [2]. Bezüglich der perioperativen Antikoagulation gibt es derzeit keine leitlinienbasierten Empfehlungen [20].…”

Section: Free Latissimus Dorsi Flap Transfer For Reconstruction Of Sounclassified

Freier Latissimus-dorsi-Transfer zur Rekonstruktion von Weichteildefekten der unteren Extremität

Knobloch

Herold

Vogt

2012

Oper Orthop Traumatol

View full text Add to dashboard Cite

From 2001-2007 75 free latissimus dorsi flaps were performed (53 ± 17 years) for soft tissue coverage at the lower extremity. In 58% the target vessel was the posterior tibial artery, in 11% the femoral artery, in 8% the anterior tibial artery and in 8% the popliteal artery. In 15% an arteriovenous (AV) loop was applied. Overall free flap survival was 95%. We encountered four total flap losses, exclusively in complex reconstructions with AV-loop situations.

show abstract

“…The commonest method of monitoring is carried out clinically and is based on subjective clinical observations. These tests are carried out on an island of skin or ‘skin paddle’—an area of skin considered to be indicative of the whole flap's arterial perfusion and venous drainage 12. Such tests may include the colour, capillary refill or blanching time, skin temperature, turgor and degree of bleeding in response to pin-prink and use of a handheld Doppler device 13…”

Section: Introductionmentioning

confidence: 99%

“…The Doppler provides monitoring for 5–10 days postoperatively and is removed by simple traction 18. A number of studies have shown that the use of this device increases success and salvage rates as it provides an earlier warning than the current method of clinical monitoring 12 21 22…”

Section: Introductionmentioning

confidence: 99%

The efficacy of the Cook-Swartz implantable Doppler in the detection of free-flap compromise: a systematic review protocol

et al. 2014

View full text Add to dashboard Cite

IntroductionThe Cook-Swartz implantable Doppler monitors venous or arterial blood flow from free flaps and can detect free-flap compromise. Previous studies have shown that the use of this Doppler can improve detection and salvage rates as it provides an earlier warning than the current method of clinical assessment. Such studies assert that the implantable Doppler is of great value in monitoring free flaps in current microsurgical units. This systematic review aims to compare the efficacy of the Cook-Swartz implantable Doppler in monitoring free-flap compromise against conventional clinical free-flap monitoring techniques.Methods and analysisVarious electronic databases will be systematically searched for studies that compare the use of Cook-Swartz implantable Doppler with clinical assessment. The selected studies will then have their titles and abstracts screened by two authors. Articles selected after title and abstract screen will have full text downloaded and the complete article will be assessed for suitability. Once the articles have been selected for inclusion, data extraction will take place. For data analysis, the outcomes of the studies will be tabulated, with descriptive statistics performed as appropriate and the detection rate of the Doppler and clinical assessment will be compared and synthesised where possible.Ethics and disseminationThe authors hope to disseminate the findings as widely as possible. This systematic review will be published in a peer-reviewed journal and include a number of recommendations as its conclusion based on the evidence contained within. Given the wide range of specialties now utilising flaps, it will be presented at a wide range of national and international conferences.Protocol Registration in PROSPEROCRD42013005818The literature search and data extraction went on until 28 January 2014. These steps were revised in line with peer review comments.

show abstract

Postoperative monitoring of lower limb free flaps with the Cook–Swartz implantable Doppler probe: A clinical trial

Cited by 35 publications

References 29 publications

Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

Freier Latissimus-dorsi-Transfer zur Rekonstruktion von Weichteildefekten der unteren Extremität

The efficacy of the Cook-Swartz implantable Doppler in the detection of free-flap compromise: a systematic review protocol

Contact Info

Product

Resources

About