Rationale for the use of the implantable Doppler probe based on 7 years' experience
M W Ho1, C Cassidy1, J S Brown2
1Regional Maxillofacial Unit, Aintree University Hospital, Liverpool, UK.
The British Journal of Oral & Maxillofacial Surgery
|April 12, 2014
Summary
The Cook-Swartz Doppler may aid in detecting compromised head and neck free flaps, especially in high-risk cases. However, it did not significantly reduce flap failure rates in this retrospective study.
Area of Science:
- Microsurgery
- Head and Neck Surgery
- Reconstructive Surgery
Background:
- Head and neck microvascular reconstruction carries a risk of flap failure, particularly in high-risk patients undergoing salvage surgery or those with osteoradionecrosis.
- Early detection of compromised flaps is crucial for successful salvage and improved patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of the Cook-Swartz implantable Doppler in monitoring microvascular free flaps in head and neck reconstruction.
- To compare outcomes between high-risk flaps monitored with the Doppler and low-risk flaps monitored clinically.
Main Methods:
- Retrospective review of 75 free flaps in 73 patients monitored with the Cook-Swartz implantable Doppler (2006-2012).
- Analysis of patient characteristics, comorbidities (ASA grade), surgical indications, and Doppler monitoring details.
- Comparison with a control group of low-risk patients (2005-2009) monitored clinically.
Main Results:
- The implantable Doppler showed a sensitivity of 67% and specificity of 95% for detecting compromised flaps.
- Higher-risk flaps monitored with Doppler had significantly higher return to theatre rates (21% vs. 4%) and flap failure rates (7% vs. 1%).
- Free flap salvage rates were similar between the Doppler-monitored and clinically monitored groups (62% vs. 60%).
Conclusions:
- The Cook-Swartz implantable Doppler may assist in earlier detection of compromised flaps in high-risk head and neck reconstructions.
- Evidence is insufficient to support the routine use of implantable Doppler for reducing flap failure in low-risk cases.
- Prospective randomized studies are needed to definitively assess the value of implantable Doppler in high-risk reconstructions.
Keywords:
Exploration free flapFlap failureFlap salvageFree flap reconstructionHead and neckImplantable DopplerMore Related Videos
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