Postoperative Monitoring of Free Flaps in Autologous Breast Reconstruction: A Multicenter Comparison of 398 Flaps Using Clinical Monitoring, Microdialysis, and the Implantable Doppler Probe
2010 (English)In: Journal of reconstructive microsurgery, ISSN 0743-684X, Vol. 26, no 6, 409-416 p.Article in journal (Refereed) Published
Many techniques for flap monitoring following free tissue transfer have been described; however, there is little evidence that any of these techniques allow for greater rates of flap salvage over clinical monitoring alone. We sought to compare three established monitoring techniques across three experienced microsurgical centers in a comparable cohort of patients. A retrospective, matched cohort study of 398 consecutive free flaps in 347 patients undergoing autologous breast reconstruction was undertaken across three institutions during the same 3-year period, with a single form of postoperative monitoring used at each institution: clinical monitoring alone, the Cook-Swartz implantable Doppler probe, or microdialysis. Both objective and subjective measures of efficacy were assessed. Clinical monitoring alone, the implantable Doppler probe, and microdialysis showed statistically similar rates of flap salvage. False-negative rates were also statistically similar (only seen in the clinically monitored group). However, there was a statistically significant increase in false-positive alarms causing needless take-backs to theater in the microdialysis and implantable Doppler arms, p < 0.001. This study did not find any technique superior to clinical monitoring alone. New monitoring technologies should be compared objectively with clinical monitoring as the current standard in postoperative flap monitoring.
Place, publisher, year, edition, pages
2010. Vol. 26, no 6, 409-416 p.
Breast reconstruction, deep inferior epigastric artery, DIEP flap, perforator flap, superficial inferior epigastric artery perforator flap, Cook probe
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-136141DOI: 10.1055/s-0030-1249607ISI: 000279057300008OAI: oai:DiVA.org:uu-136141DiVA: diva2:376496