Intraoperative Utility of the Implantable Doppler in Lower Extremity Reconstruction: A Matched Case-control Study

Patients with diabetes mellitus and peripheral vascular disease have high rates of thrombogenic vessels. The implantable (Cook) Doppler in lower extremity reconstruction can optimize microsurgical outcomes in this population.

Patients undergoing lower extremity free flap reconstruction who did not have an implantable Doppler probe placed were matched with patients who received an implantable Doppler probe. Groups were matched based on wound location, history of peripheral vascular disease, number of vessel runoffs, and number of venous anastomoses and postoperative outcomes compared.

Thirty patients were included: 15 in the control group and 15 in the implantable Doppler group. Mean age was 60.2 ±10.2 years, and mean BMI was 28.7 ± 5.0 kg/m². There was a high prevalence of diabetes mellitus (13; 43.3%) and peripheral vascular disease (4; 13.3%). Takebacks due to vascular compromise were significantly higher in the control than in the implantable Doppler group (26.7% versus 0.0%, P = 0.032). Among flaps that required takeback to the operating room, the majority were muscle-based without a skin paddle (75.0%). Vascular compromise was due to arterial insufficiency in 2 cases and venous thrombosis in 1 case. The salvage rate among the takebacks of the non-implantable Doppler group was 0.0%, resulting in a 26.7% flap failure rate in the non-implantable Doppler group when compared with 0.0% flap loss in the implantable Doppler group (P = 0.032).

The implantable Doppler probe optimizes flap inset intraoperatively in lower extremity free flap reconstruction and can significantly decrease takebacks due to vascular complications, thereby increasing flap success.