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J Reconstr Microsurg 2018; 34(03): 218-226
DOI: 10.1055/s-0037-1608628
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of the Implantable Doppler Probe for Free Flap Monitoring in Lower Limb Reconstruction

Yvonne Lenz
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
Ruth Gross
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
Vincenzo Penna
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
Holger Bannasch
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
G. Bjoern Stark
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
,
Steffen U. Eisenhardt
1   Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
› Author Affiliations
Funding None of the authors have a financial interest in any of the products or devices mentioned in this article.
Further Information

Publication History

20 June 2017

28 September 2017

Publication Date:
27 November 2017 (online)

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Abstract

Background Timely reexploration and reanastomoses can salvage failing free flaps. The use of the implantable Doppler probe provides direct evidence of vascular impairment of the microvascular anastomoses and allows for postoperative NPWT. The aim of this retrospective study was to compare the Doppler probe to conventional monitoring techniques for free flap monitoring in lower limb reconstruction and to identify risk factors for perfusion disturbance and reexploration.

Methods All patients receiving free muscle flap reconstruction for lower limb soft tissue defects at our department from 2000 to 2013 were included, and all adverse events, timely detection of perfusion problems, and outcome of revision surgery were assessed by chart analysis.

Results For lower limb reconstruction, 110 free muscle transfers were performed of which 41 muscle flaps were conventionally monitored and 69 flaps were monitored using the implantable Doppler probe. In 18 cases, the free muscle flaps needed revision because of perfusion disturbances. The salvage rate was 80% with monitoring by the implantable Doppler probe compared with 62.5% using conventional monitoring methods resulting in success rates of 95.7 and 92.7%, respectively.

Conclusion The use of the implantable Cook–Swartz Doppler probe represents a safe monitoring method for lower limb reconstruction, which allows for the additional use of NPWT. Higher salvage and revision success rates can be attributed to an earlier detection of perfusion impairment. However, a larger patient cohort is necessary to verify superiority over conventional postoperative monitoring.

Keywords

lower limb reconstruction - postoperative monitoring - implantable Doppler probe - free muscle flap - microsurgery

Ethical Approval

The study was approved by the ethics committee of the University of Freiburg Medical Center.


Note

A part of this work was presented at the 38th Annual Conference of the German-Speaking Working Group for Peripheral Nerves and Vascular Microsurgery (DAM) held from December 3 to December 5, 2015, at Bochum, Germany.