External monitoring of vascularized jejunum transfers using laser Doppler flowmetry

Any buried free tissue transfer presents a dilemma for postoperative monitoring, and the vascularized jejunum as used for head and neck reconstruction is no exception. Exteriorization of a small common segment of the jejunum in a sense permits direct visualization. Objective assessment may then simultaneously be possible with a harmless external probe sewn onto the serosa. The laser Doppler blood perfusion monitor as one such device provides a simple means for continuous analysis of the adequacy of the jejunal circulation. Intraperitoneal in situ monitoring of isolated island jejunal segments has shown significant, immediate alteration of flow regardless of whether the vein or artery has been occluded. The laser Doppler has also proved accurate after transfer in predicting impending flap failure even though peristalsis and serosal color appeared normal on direct inspection.