What Are the Optimal Monitoring Techniques in Head and Neck Microvascular Reconstruction?

Abstract

Purpose: We evaluated the outcomes for widely used systems in terms of accuracy, salvage rates, and added cost compared to conventional monitoring. Methods: We performed a narrative review of the literature (high-impact report). Results: The overall free flap success for head and neck reconstruction is at least 95% using any type of monitoring. Salvage rates in decreasing frequency of monitoring techniques are 85% with near-infrared spectroscopy (NIRS), 81% with implantable Doppler, and 61.5% with conventional monitoring. False-positive rates in increasing frequency are 0% for NIRS, 0.4% for conventional monitoring, and <10% for implantable Doppler. Current data show implantable Doppler to be potentially cost-effective for institutions with a failure rate of at least 6%. Buried flaps may be monitored with conventional monitoring using an exteriorized paddle, or using implantable Doppler. Conclusions: The cost-effectiveness of advanced flap monitoring systems beyond conventional monitoring is related to the success rate of each institution. Cost-effectiveness studies are necessary to determine at what point NIRS becomes advantageous.

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

“…There have been many criteria used for classification of monitoring methods. Moubayed 18 for example made two classes namely; (a) widely used -DVM and Doppler, near-infrared spectroscopy and (b) experimental -all other methods. Schoeller 19 chose objectivity of the method as the criteria and concluded that his two classes were; (a) subjective -DVM and (b) objective -all the other methods.…”

“…An ideal monitoring technique therefore should be easy to apply, objective, continuous, non-invasive, safe, inexpensive, easily and validly interpreted by medical and nursing staff and cost-effective 18,42,177 . More than 40 monitoring methods have been reported over a 45-year period of using MF's, the first of course being DVM.…”

“…But the salvage rate ratio (:) to false-positive rate in percentage were 95:0 for near infrared spectroscopy, 81:10 for implantable Doppler and 61.5:0.4 for DVM (ref. 18 ).…”

“…20 ). Looking at direct expenses only for DVM, the initial outlay is near 0 USD and per patient are near 0 USD, for handheld Doppler costs are initially100 USD and 0/patient, for implantable Doppler initially 3.100 USD and 400/patient and for near infrared spectroscopy initially 19.500 USD and 650/patient 18 . Poder in 2013 estimated the personnel costs per flap using an implantable Doppler were approximately 200 CAD (ref.…”

“…In 1975 Creech suggested that the ideal monitoring method should be selected using benefit to the patient as the only criteria 177 . However in 2010 Sakakibara and then in 2016 Moubayed reported that cost effectiveness should also be taken into account 18,42 . It is generally accepted that the worlds public healthcare systems are becoming more and more financially demanding and funds needed to cover medical care are increasing rapidly.…”