The use of sentinel skin islands for monitoring buried and semi-buried micro-vascular flaps. Part I: Summary and brief description of monitoring methods

Abstract

Micro-vascular flaps have been used for the repair of challenging defects for over 45 years. The risk of failure is reported to be around 5-10% which despite medical and technical advances in recent years remains essentially unchanged. Precise, continuous, sensitive and specific monitoring together with prompt notification of vascular compromise is crucial for the success of the procedure. In this review, we provide a classification and brief description of the reported methods for monitoring the micro-vascular flap and a summary of the benefits over direct visual monitoring. Over 40 different monitoring techniques have been reported but their comparative merits are not always obvious. One looks for early detection of a flap's compromise, improved flap salvage rate and a minimal false-positive or false-negative rate. The cost-effectiveness of any method should also be considered. Direct visualisation of the flap is the method most generally used and still seems to be the simplest, cheapest and most reliable method for flap monitoring. Considering the alternatives, only implantable Doppler ultrasound probes, near infrared spectroscopy and laser Doppler flowmetry have shown any evidence of improved flap salvage rates over direct visual monitoring.

Complex reconstruction of the clavicle with a prefabricated medial femur condyle chimeric flap including a superficial circumflex iliac artery perforator flap: A case report

“…In the field of monitoring buried free flaps, numerous devices have been reported in the existing literature ranging from Dopplers to state of the art wireless implantable optical probes (Guo et al, 2022; Molitor et al, 2021a, 2021b). Among these devices, implantable Dopplers have gained significant popularity and may have been utilized in our specific case (Agha et al, 2014; Dunklebarger et al, 2022; Tabrizi et al, 2021).…”

The feasibility of nipple-sparing mastectomy in combined with abdominal free flap breast reconstruction without skin paddles for flap monitoring: a single-center experience

“…The essential problem of buried ap breast reconstruction is ap monitoring without a skin paddle. A traditional trans-cutaneous handheld doppler might not be su cient to monitor the blood ow of the ap after anastomosis [27]. Thus, implantable Doppler probes (Cook-Swartz) was invented in 1984 [28], which was suggested for buried ap monitoring [29].…”

“…Furthermore, we noticed that several novel approaches could be incorporated to improve the e cacy and safety of our monitoring protocol. For example, indocyanine-green uorescence video angiography, hydrogen clearance, CT angiography, MRI angiography, scintigraphy, micro-dialysis, and/or pH monitoring were all potential methods for blood ow monitoring [27]. Further studies are needed to address these methods.…”