Routine use of laser Doppler flowmetry for monitoring autologous tissue transplants

This is a report of a prospective study in which 41 consecutive autologous tissue transplants were monitored using the Laserflo BPM model 403 laser Doppler monitor (TSI Inc., St. Paul, MN). Flaps were monitored both intraoperatively and postoperatively, and clinical flap monitoring was compared with laser Doppler monitoring. Twenty-nine flaps had no problems as indicated by clinical or Doppler measurement. Twelve flaps underwent 13 reexplorations; one flap was explored twice. Five venous and five arterial anastomoses were corrected, with complete survival of the flaps. Three hematomas were evacuated. Two of these flaps failed. There were no instances where the laser Doppler indicated a problem with flap viability that subsequently did not merit reexploration. There were no instances of flap failure undetected by the laser Doppler. In comparison to the clinical monitoring, laser Doppler monitoring was more rapid and more precise in identifying problems with the flap. The use of this monitor has improved our salvage rate for flap reexploration from 50 to 85% and has provided a more objective standard for both nurses and physicians to evaluate flaps in the perioperative period.