Download PDF
Semin Plast Surg 2019; 33(01): 013-016
DOI: 10.1055/s-0039-1677880
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Free-Flap Monitoring Techniques

Scott Kohlert
1   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
,
Alexandra E. Quimby
2   Department of Otolaryngology – Head and Neck Surgery, University of Ottawa, Ottawa, Canada
,
Masoud Saman
3   Saman Center for Facial Plastic Surgery, Plano, Texas
,
Yadranko Ducic
4   Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
08 March 2019 (online)

    Permissions and Reprints

Abstract

Free tissue transfer is commonly employed in the reconstruction of large or complicated defects. Postoperative flap failure from microvascular compromise is an uncommon but major potential complication of this procedure. As such, many postoperative monitoring techniques devices have been developed. This paper provides an overview of the wide variety of options available for surgeons today.

Keywords

free flap - postoperative monitoring - microvascular reconstruction
 

  • References

  • 1 Millican PG, Poole MD. Peripheral neovascularisation of muscle and musculocutaneous flaps. Br J Plast Surg 1985; 38 (03) 369-374
    CrossrefPubMedGoogle Scholar
  • 2 Khoo CT, Bailey BN. The behaviour of free muscle and musculocutaneous flaps after early loss of axial blood supply. Br J Plast Surg 1982; 35 (01) 43-46
    CrossrefPubMedGoogle Scholar
  • 3 Kumar K, Jaffe W, London NJ, Varma SK. Free flap neovascularization: myth or reality?. J Reconstr Microsurg 2004; 20 (01) 31-34
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Qian Y, Li G, Zang H. , et al. A systematic review and meta-analysis of free-style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open 2018; 6 (02) e1651
    CrossrefPubMedGoogle Scholar
  • 5 Hyodo I, Nakayama B, Kato H. , et al. Analysis of salvage operation in head and neck microsurgical reconstruction. Laryngoscope 2007; 117 (02) 357-360
    CrossrefPubMedGoogle Scholar
  • 6 Brown JS, Devine JC, Magennis P, Sillifant P, Rogers SN, Vaughan ED. Factors that influence the outcome of salvage in free tissue transfer. Br J Oral Maxillofac Surg 2003; 41 (01) 16-20
    CrossrefPubMedGoogle Scholar
  • 7 Miyasaka M, Ichikawa K, Nishimura M. , et al. Salvage operations of free tissue transfer following internal jugular venous thrombosis: a review of 4 cases. Microsurgery 2005; 25 (03) 191-195
    CrossrefPubMedGoogle Scholar
  • 8 Schusterman MA, Miller MJ, Reece GP, Kroll SS, Marchi M, Goepfert H. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994; 93 (03) 472-478 , discussion 479–480
    CrossrefPubMedGoogle Scholar
  • 9 Kroll SS, Schusterman MA, Reece GP. , et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg 1996; 98 (03) 459-463
    CrossrefPubMedGoogle Scholar
  • 10 Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg 1998; 102 (03) 722-732 , discussion 733–734
    CrossrefPubMedGoogle Scholar
  • 11 Yang Q, Ren ZH, Chickooree D. , et al. The effect of early detection of anterolateral thigh free flap crisis on the salvage success rate, based on 10 years of experience and 1072 flaps. Int J Oral Maxillofac Surg 2014; 43 (09) 1059-1063
    CrossrefPubMedGoogle Scholar
  • 12 Ho MW, Brown JS, Magennis P. , et al. Salvage outcomes of free tissue transfer in Liverpool: trends over 18 years (1992-2009). Br J Oral Maxillofac Surg 2012; 50 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 13 Novakovic D, Patel RS, Goldstein DP, Gullane PJ. Salvage of failed free flaps used in head and neck reconstruction. Head Neck Oncol 2009; 1: 33
    CrossrefPubMedGoogle Scholar
  • 14 Chen KT, Mardini S, Chuang DC. , et al. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 2007; 120 (01) 187-195
    CrossrefPubMedGoogle Scholar
  • 15 Kroll SS, Schusterman MA, Reece GP. , et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 1996; 98 (07) 1230-1233
    CrossrefPubMedGoogle Scholar
  • 16 Spiegel JH, Polat JK. Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques. Laryngoscope 2007; 117 (03) 485-490
    CrossrefPubMedGoogle Scholar
  • 17 Patel UA, Hernandez D, Shnayder Y. , et al. Free flap reconstruction monitoring techniques and frequency in the era of restricted resident work hours. JAMA Otolaryngol Head Neck Surg 2017; 143 (08) 803-809
    CrossrefPubMedGoogle Scholar
  • 18 Chao AH, Meyerson J, Povoski SP, Kocak E. A review of devices used in the monitoring of microvascular free tissue transfers. Expert Rev Med Devices 2013; 10 (05) 649-660
    CrossrefPubMedGoogle Scholar
  • 19 Van Genechten M, Rahmel B, Batstone MD. Red or white? Use of high colour-rendering index, light-emitting diodes in monitoring of free flaps of the head and neck. Br J Oral Maxillofac Surg 2015; 53 (08) 765-766
    CrossrefPubMedGoogle Scholar
  • 20 Varadarajan VV, Arshad H, Dziegielewski PT. Head and neck free flap reconstruction: what is the appropriate post-operative level of care?. Oral Oncol 2017; 75: 61-66
    CrossrefPubMedGoogle Scholar
  • 21 Han ZF, Guo LL, Liu LB. , et al. A comparison of the Cook-Swartz Doppler with conventional clinical methods for free flap monitoring: a systematic review and a meta-analysis. Int J Surg 2016; 32: 109-115
    CrossrefPubMedGoogle Scholar
  • 22 Vakharia KT, Henstrom D, Lindsay R, Cunnane MB, Cheney M, Hadlock T. Color Doppler ultrasound: effective monitoring of the buried free flap in facial reanimation. Otolaryngol Head Neck Surg 2012; 146 (03) 372-376
    CrossrefPubMedGoogle Scholar
  • 23 Schön R, Schramm A, Gellrich NC, Maier W, Düker J, Schmelzeisen R. Color duplex sonography for the monitoring of vascularized free bone flaps. Otolaryngol Head Neck Surg 2003; 129 (01) 71-76
    CrossrefPubMedGoogle Scholar
  • 24 Sekido M, Yamamoto Y, Sugihara T. Arterial blood flow changes after free tissue transfer in head and neck reconstruction. Plast Reconstr Surg 2005; 115 (06) 1547-1552
    CrossrefPubMedGoogle Scholar
  • 25 Khalid AN, Quraishi SA, Zang WA, Chadwick JL, Stack Jr BC. Color Doppler ultrasonography is a reliable predictor of free tissue transfer outcomes in head and neck reconstruction. Otolaryngol Head Neck Surg 2006; 134 (04) 635-638
    CrossrefPubMedGoogle Scholar
  • 26 Swartz WM, Jones NF, Cherup L, Klein A. Direct monitoring of microvascular anastomoses with the 20-MHz ultrasonic Doppler probe: an experimental and clinical study. Plast Reconstr Surg 1988; 81 (02) 149-161
    CrossrefPubMedGoogle Scholar
  • 27 Schmulder A, Gur E, Zaretski A. Eight-year experience of the Cook-Swartz Doppler in free-flap operations: microsurgical and reexploration results with regard to a wide spectrum of surgeries. Microsurgery 2011; 31 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 28 Rozen WM, Chubb D, Whitaker IS, Acosta R. The efficacy of postoperative monitoring: a single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps. Microsurgery 2010; 30 (02) 105-110
    CrossrefPubMedGoogle Scholar
  • 29 Ferguson Jr RE, Yu P. Techniques of monitoring buried fasciocutaneous free flaps. Plast Reconstr Surg 2009; 123 (02) 525-532
    CrossrefPubMedGoogle Scholar
  • 30 Rosenberg JJ, Fornage BD, Chevray PM. Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test. Plast Reconstr Surg 2006; 118 (01) 109-113 , discussion 114–115
    PubMedGoogle Scholar
  • 31 Poder TG, Fortier PH. Implantable Doppler in monitoring free flaps: a cost-effectiveness analysis based on a systematic review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130 (02) 79-85
    CrossrefPubMedGoogle Scholar
  • 32 McCraw JB, Myers B, Shanklin KD. The value of fluorescein in predicting the viability of arterialized flaps. Plast Reconstr Surg 1977; 60 (05) 710-719
    CrossrefPubMedGoogle Scholar
  • 33 Betz CS, Zhorzel S, Schachenmayr H. , et al. Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green: a pilot study. J Plast Reconstr Aesthet Surg 2013; 66 (05) 667-674
    CrossrefPubMedGoogle Scholar
  • 34 Yang K, Mu L, Liu Y, Peng Z, Li G. Application value of indocyanine green angiography in flap reconstructive surgery [. in Chinese ]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29 (09) 1113-1116
    PubMedGoogle Scholar
  • 35 Casey III WJ, Connolly KA, Nanda A, Rebecca AM, Perdikis G, Smith AA. Indocyanine green laser angiography improves deep inferior epigastric perforator flap outcomes following abdominal suction lipectomy. Plast Reconstr Surg 2015; 135 (03) 491e-497e
    CrossrefPubMedGoogle Scholar
  • 36 Jones JW, Wiebalck R. Continuous postoperative free-flap monitoring with an EKG-interfaced photoplethysmograph. J Reconstr Microsurg 1992; 8 (01) 61-62
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Top H, Sarikaya A, Aygit AC, Benlier E, Kiyak M. Review of monitoring free muscle flap transfers in reconstructive surgery: role of 99mTc sestamibi scintigraphy. Nucl Med Commun 2006; 27 (01) 91-98
    CrossrefPubMedGoogle Scholar
  • 38 Jung EM, Prantl L, Schreyer AG. , et al. New perfusion imaging of tissue transplants with Contrast Harmonic Ultrasound Imaging (CHI) and Magnetic Resonance Imaging (MRI) in comparison with laser-induced Indocyanine Green (ICG) fluorescence angiography. Clin Hemorheol Microcirc 2009; 43 (1-2): 19-33
    PubMedGoogle Scholar
  • 39 Guillier D, Moris V, Cristofari S. , et al. Monitoring of myocutaneous flaps by measuring capillary glucose and lactate levels: experimental study. Ann Plast Surg 2018; 80 (04) 416-423
    CrossrefPubMedGoogle Scholar