Postoperative monitoring and salvage of microvascular free flaps

We believe that it is essential to closely monitor the viability of any free flap in order to decrease potential morbidity to the patient. A myriad of techniques have been described, many of which appear quite promising; none has been widely accepted. We believe that clinical assessment of an exposed portion of a free flap is the most reliable method of postoperative "surveillance"; however, continuous observation by the surgeon is impractical. Other monitoring techniques, such as laser-Doppler flowmetry, allow nursing personnel to observe the patient in order to alert the surgeon at the first sign of trouble. Adjunctive monitoring techniques are currently imperfect and, in general, expensive. The cost must be measured, however, against the potential loss of a flap and its subsequent consequences. Until an "ideal" monitoring technique becomes available, a combination of some of the techniques described here will enable the surgeon to maximize the chances of salvaging a failing flap.