The Effect of an Implantable Doppler Probe on the Salvage of Microvascular Tissue Transplants

Kind, Gabriel M.; Buntic, Rudolf F.; Buncke, Gregory M.; Cooper, Timothy M.; Siko, Peter P.; Buncke, Harry J.

doi:10.1097/00006534-199804010-00016

Cited by 121 publications

(44 citation statements)

References 13 publications

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“…Mean re-exploration time for salvage cases was 1.3 days compared with 3.9 days for those not salvaged. (16) Kind et al (17) suggested that a miniature doppler ultrasonic probe attached directly to the outflow vein of the flap may lead to a significant improvement in the salvage rates of free flaps. They identified 20 instances of vascular compromise in 147 free flaps using this technique with a salvage rate of 100%.…”

Section: Discussionmentioning

confidence: 99%

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

2016

IJASHNB

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The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in Maxillofacial reconstruction. Although associated complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction. With early recognition and prompt intervention salvage of compromised flap is possible. The purpose of this article is to emphasise the importance of keeping low threshold for re-exploration in situation of any suspected failing free flap. Pt ReportA 60 year-old male patient presented with an ulcero-proliferative mass measuring around 4cmx3.5 cm which involved the right lip mucosa and had infiltrated the underlying tissue to appear over the skin with central zone of necrosis and surrounding erythematous induration. (Fig. 1) Incisional biopsy from mucosal surface of the lesion revealed well to moderately differentiated squamous cell carcinoma. The neck was clinically N0 which similarly correlated following contrast CT scan of the neck. The surgical planning for the tumour was wide excision, SOND (Supra Omohyoid neck dissection) and reconstruction of the defect with FRAFF. Wide excision of the primary lesion was carried out along with the SOND on the affected side.The neck dissection was done with extreme care to preserve the facial vessels when dissecting level IB. Dissection of the submandibular gland was done by safely ligating the submandibular branches of the facial artery to the gland and preserving the whole artery along its course on the posterior aspect of the gland. The right lip commissure involving lateral one third of the lower lip, part of skin in the cheek along with underlying part of cheek musculature, inner buccal and labial mucosa, gingivo-buccal sulcus and gingiva along with the alveolar bone sparing the lower border of the mandible were resected. The size of the primary defect following tumour resection was 5.2x4.8x3.7 cm. The reconstruction of the surgical defect was done with FRAFF. On completion of the reconstruction the flap looked well perfused and healthy. The flap was monitored clinically at an hourly basis. By 4 th -5 th hours mild ooze from the drain port had become noticeable along with marked oedema in the flap. (Fig. 2) On the 8 th hour post operatively there was dusky appearance of the flap, along with oedema. On needle prick there was dark blood ooze from the flap and therefore the decision for re exploration was taken suspecting venous compromise. On re exploration a huge hematoma was noticed under the flap, around the anastomosis and along the IJV. The clots were delicately removed. The adjoining areas were irrigated with warm saline, and venous and arterial anastomoses were evaluated. There were no clots in the vein and normal flow through the artery was seen. Acland's "milking" test was performed. In the test the artery was occluded with a forceps immediately caudal to anastomosis and then with a second forceps artery was occl...

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Section: Discussionmentioning

confidence: 99%

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

2016

IJASHNB

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“…This includes observing skin colour, temperature, capillary refill and pinprick testing (5,7,8). However, as demonstrated by Swartz (3,4) (2), in a 1998 review of the Buncke Clinic experience, reported a significantly improved free flap salvage rate, from a pre-Doppler rate of 71% to 100% with Doppler monitor use.…”

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confidence: 99%

“…Salvage rates for failing free flaps have not increased to the same degree. It is suggested by several authors that this is a result of late detection of vascular compromise in the flap (2)(3)(4)(5).…”

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confidence: 99%

“…The utility of the implantable Doppler for intraoperative monitoring has been alluded to in previous articles (2,3,8), but has not been specifically studied. It is suggested that this period is actually more critical than the postoperative monitoring period in early detection of vascular compromise (2,3,8).…”

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confidence: 99%

“…It is suggested that this period is actually more critical than the postoperative monitoring period in early detection of vascular compromise (2,3,8).…”

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confidence: 99%

See 2 more Smart Citations

Why do free flap vessels thrombose? Lessons learned from implantable Doppler monitoring

Williams¹,

French²

2004

J Plast Surg

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The Implantable Cook-Swartz Doppler Probe for Postoperative Monitoring in Head and Neck Free Flap Reconstruction

Guillemaud¹,

Seikaly²,

Côté³

et al. 2008

Arch Otolaryngol Head Neck Surg

102

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Patients: A consecutive series of 351 patients (244 men and 107 women; mean age, 58.63 years) who underwent free flap reconstruction of head and neck defects that were monitored using the implantable Doppler probe were included. Results: The most common indication for surgery was squamous cell carcinoma (81.0%), followed by functional reconstruction (4.3%). The most common free flap used was radial forearm (68.0%), followed by the fibular free flap (19.0%). With operative exploration used as the gold standard, the Cook-Swartz Doppler Flow Monitoring System had a sensitivity of 65.8% and specificity of 98.2% for the detection of flap compromise. For the detection of vascular compromise of the monitored vessel (excluding flap compromise cases whereby flow in the monitored vessel was not compromised on operative exploration, ie, venous obstruction, hematoma formation, and necrotizing fasciitis), the sensitivity increased to 100%. Conclusions: This is the largest reported series, to our knowledge, of implantable Cook-Swartz Doppler use, and our experience would suggest that this is a reliable technique for postoperative monitoring in head and neck reconstruction. Our use of the implantable Doppler probe allowed us to recognize vascular compromise early, resulting in an overall flap success rate of 98.1%, with a 92.0% salvage rate of flaps that experienced vascular compromise of the monitored vessel.

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The Effect of an Implantable Doppler Probe on the Salvage of Microvascular Tissue Transplants

Cited by 121 publications

References 13 publications

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

Why do free flap vessels thrombose? Lessons learned from implantable Doppler monitoring

The Implantable Cook-Swartz Doppler Probe for Postoperative Monitoring in Head and Neck Free Flap Reconstruction

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