Flap monitoring and patient management

Complications in free-tissue transfer patients cannot be completely prevented; however, the incidence may be significantly reduced by a thorough preoperative evaluation and initiation of prophylactic strategies, meticulous surgical technique, and diligent postoperative monitoring. Emergent exploration must be performed soon after obstruction occurs if it is to be successful, and early exploration and repair is likely in compromised flaps if they are monitored frequently in the initial postoperative period. This article reviews the importance of clinical management in this patient population, the recommended frequency of flap monitoring, and the most commonly used methods of monitoring the transferred tissue whether or not the flap is readily visible. The authors also review the anticoagulants used and a postoperative flap monitoring protocol.