Fibrin Sealant: A Novel Method of Fixation for an Implantable Ultrasonic MicroDoppler Probe

Abstract

While free tissue transfer affords the reconstructive microvascular surgeon the ability to provide coverage for complex wounds, the postoperative monitoring of these flaps continues to evolve. The most recent advance has been the development of an implantable microDoppler probe to provide an early warning signal for vascular obstruction. The current system relies on the use of a silicone cuff to secure a 1-mm probe to the outflow vein. The release force to remove the probe from the cuff is reported to be 1/10 of a pound (45 g). A disadvantage of this system is the need for a circumferential, relatively inelastic device around the vein. Should the cuff be too tightly secured to the vein, the potential for outflow obstruction exists. Moreover, if the probe is not well-approximated to the vein, no signal is produced. Finally, the fact that a foreign body remains in the wound after completion of the monitoring period remains a concern. The authors have investigated a new method to adhere the probe, using a commercially available fibrin sealant. The use of this biocompatible substance has the potential to obviate the need for the current method of fixation, and the associated concerns.

Advancements in Free Flap Monitoring in the Last Decade: A Critical Review

“…Different methods have been described to attach the cuff around the vein, including microclips, 20 sutures, 21 and fibrin sealant, 22 all with good results. Postoperatively, the surgeon, nursing staff, and the patient are able to hear the audible venous signal.…”

Current Evidence for Postoperative Monitoring of Microvascular Free Flaps

“…68 A Cook-Swartz implantable Doppler probe directly measures the blood flow in the pedicle and consists of a silicone cuff approximately 5 mm in width containing a 20-MHz piezoelectric crystal. The cuff is secured around the venous pedicle using microclips, 69 sutures, 70 a fibrin sealant, 71 or an elongated silicone cuff. 72,73 Earlier studies placed the probe around arterial pedicle, but subsequent studies demonstrated that it is more sensitive when placed on the venous anastomosis.…”

Intraoperative Micro-Doppler in Cerebral Arteriovenous Malformations

“…9 Other authors described the utility of IOMD in spinal AV fistulas, microvascular anastomosis of moyamoya disease, and the transposition of vessel flaps. 6,8,[10][11][12]14,17,18 However, IOMD in cerebral AVMs has not been systematically analyzed before. None of the studies went into detail about the surprisingly low systolic and diastolic flow velocities.…”