Outcome of microvascular free flaps in a high-volume training centre

Al‐Dam, Ahmed; Zrnc, Tomislav; Hanken, Henning; Riecke, Björn; Eichhorn, Wolfgang; Nourwali, Ibrahim; Smeets, Ralf; Blessmann, Marco; Heiland, Max; Gröbe, Alexander

doi:10.1016/j.jcms.2014.02.005

Cited by 34 publications

(25 citation statements)

References 38 publications

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“…6 Like other authors, we have analysed the impact of perioperative factors that lead not only to the failure of different kinds of free flaps but also to the need for revisions. [7][8][9] We have reported an overall success rate of 96% over a period of 6 years, which compares well with other published data ( Table 1).…”

Section: Discussionsupporting

confidence: 91%

Perioperative factors that influence the outcome of microsurgical reconstructions in craniomaxillofacial surgery

Preidl

Wehrhan

Schlittenbauer

et al. 2015

British Journal of Oral and Maxillofacial Surgery

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Section: Discussionsupporting

confidence: 91%

Perioperative factors that influence the outcome of microsurgical reconstructions in craniomaxillofacial surgery

Preidl

Wehrhan

Schlittenbauer

et al. 2015

British Journal of Oral and Maxillofacial Surgery

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“…For another, the salvage rate for the clinically assessed groups in 3 of 5 studies ranged from 32% to 46%, which was inferior to the 70% to 80% range in the clinically assessed groups treated by more experienced physicians. 5,6 This finding might suggest that using an implantable Doppler probe might not be significantly more efficacious for physicians with a relatively high salvage rate using clinical assessment. Moreover, the latter group of technically proficient physicians might tend not to report their experience or even not to use the implantable Doppler probe.…”

Section: Discussionmentioning

confidence: 99%

Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis

Chang

Lee

Lin

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Although clinical assessment remains the gold standard for monitoring the circulation of free flaps, several adjunct techniques promote timely salvage by detecting circulation compromise early. The objective of this systematic review was to evaluate the efficacy of an implantable Doppler probe for postoperatively monitoring free flaps.Materials and Methods:English-language articles evaluating the efficacy of implantable Doppler probes compared with clinical assessment for postoperatively monitoring free flaps were analyzed. The outcome measures were total flap failure rates, salvage rates, sensitivity, false-positive rates, and positive likelihood ratios.Results:Of the 504 citations identified, 6 comparative studies were included for meta-analysis. An implantable Doppler probe significantly lowered the flap failure rate (risk ratio: 0.40; 95% confidence interval: 0.21–0.75) and raised the successful salvage rate (risk ratio: 1.73; 95% confidence interval: 1.16–2.59). Pooled sensitivity was higher (1.00 vs 0.98), the positive likelihood ratio was lower (72.16 vs 220.48), and the false-positive rate was higher (0.01 vs 0) in the implantable Doppler probe group than in the clinical assessment group.Conclusion:An implantable Doppler probe is significantly more efficacious than clinical assessment for postoperatively monitoring free flaps.

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“…The use of clinical monitoring has been shown to salvage some of these threatened flaps, with some experienced groups showing that salvage of approximately 70% to 80% of compromised free flaps is possible. [11][12][13][14] Flap failures may be attributed to arterial or venous occlusion arising from thrombosis, external compression, vessel kinking, or hematoma. Available evidence and expert opinions both indicate that timely detection of flap compromise and subsequent reexploration significantly increases the rate of flap salvage.…”

mentioning

confidence: 99%