Reduced cost of extremity free flap monitoring

We analyzed the results and cost-effectiveness of our protocol for free flap monitoring in extremity patients. Of 70 consecutive free flaps to the upper and lower extremity that were monitored by laser Doppler flowmeter, 62 were managed on the hospital ward immediately after recovery from general anesthesia. The duration of laser Doppler monitoring was 5 days. Perfusion compromise occurred in three flaps, two of which occurred in the recovery room and were initially detected by the laser Doppler and successfully salvaged by early exploration. The average equipment cost for the use of the laser Doppler flowmeter for 5 days was significantly less than the cost of an intensive care unit bed for a single day. Our experience confirms that monitoring free flaps with laser Doppler is cost-effective and indicates that a specialized care bed after the recovery room is not necessary in routine extremity cases. Since no vascular complication occurred beyond the second postoperative day, this study suggests that the duration of laser Doppler monitoring can be discontinued on the third postoperative day.