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MONITORING BURIED FREE FLAPS – NEW ZEALAND’S FIRST FOUR CLINICAL CASES OF FREE FLAP MONITORING WITH IMPLANTABLE 20 MHZ ULTRASONIC DOPPLER PROBE
Author(s) -
Mistry Y.,
James D. W.,
Sinclair S.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04127_42.x
Subject(s) - medicine , free flap , anastomosis , surgery , doppler effect , laser doppler velocimetry , vein , breast reconstruction , blood flow , radiology , physics , cancer , astronomy , breast cancer
Purpose Monitoring buried free flaps is difficult. Currently in NZ only standard methods of clinical examination and surface doppler are used. We review the first four cases of the Cook Swartz Doppler (CSD) blood flow monitoring system in monitoring free flaps. Method Retrospective review of the first four clinical applications of the CSD in NZ between October 2006 to January 2007. The doppler was used by 3 different surgeons and interpreted by nursing and medical staff with no prior experience with the device. There were two cases of buried free flaps and two cases where a small skin monitor was utilised to allow clinical correlation with doppler signals. Discussions were held with respective surgeons and other relevant medical and nursing staff. Results In the two buried flaps (vascularised fibula flap for femur reconstruction and an ALT flap for pharyngeal reconstruction) the probe was inserted downstream of the arterial anastomosis. In the two non‐buried flaps (latissimus dorsi to reconstruct a scalp defect and a free TRAM for breast reconstruction) the probe was inserted upstream of the venous anastomosis. There can be difficulty in interpreting the audible signal when the probe is attached to the vein. All surgeons found the technical aspects of inserting and securing the probe to be straightforward. It provided peri‐ and post‐operative assurance of flap viability. All four flaps were viable at one week at the time of probe wire removal. Conclusion The CSD system is easily applicable to our clinical practice and requires minimal training for both the clinical and nursing staff. It provided peri‐ and post‐operative assurance of flap viability.