Variations in the postoperative management of free tissue transfers to the head and neck in the United Kingdom

The efficacy of postoperative monitoring: A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps

“…[1][2][3][4][5][6] Currently, the only method that is ubiquitous amongst microsurgical units is the use of clinical monitoring. 7,8 Although some studies have demonstrated that adjunctive monitoring techniques may have benefit, and indeed that flap salvage rate may be increased, [9][10][11] there are still no large-scale comparative trials supporting these studies. Without reasonable evidence for new monitoring techniques, bedside monitoring has remained the norm, with some units using adjunctive techniques at the discretion of the surgeon.…”

“…Without reasonable evidence for new monitoring techniques, bedside monitoring has remained the norm, with some units using adjunctive techniques at the discretion of the surgeon. 7,8 The implantable Doppler probe manufactured by Cook 1 has been the subject of several recent articles in the plastic surgery literature. 10,[12][13][14][15][16][17][18][19][20] Despite these recent publications, only one previous study assessing the implanted Doppler probe has used clinically relevant endpoints as its primary outcome measure.…”

Early reintervention of compromised free flaps improves success rate

“…Conventional monitoring techniques include clinical observation, handheld Doppler ultrasonography, surface temperature probes, and pinprick tests, all techniques that are still widely used today. 8,9 Newer methods that have been developed for monitoring are tissue spectophotometry, laser Doppler flowmetry, and tissue oxygen pressure measuring probes. [10][11][12] Although the conventional techniques mentioned above are reliable in most flaps, they are not in buried flaps because of their external component.…”

“…15,16 Despite the almost five decades of experience in free flap transplants, a general accepted protocol on the method, duration, and frequency of monitoring still has to be developed. 8,9 A common used monitoring regime is a check every hour in the first 24 h postsurgery, every 1 or 2 h the second day and every 4 h the third day. 8 To achieve a more general accepted schedule of monitoring, we focus in this report on the time interval between the ending of ischemia during the initial reconstruction and the start of the revision (FS-time).…”

Experience of 592 free tissue transfers: the case for clinical assessment alone to monitor free flaps

“…The fact that this is the only type of monitoring used by many centres worldwide demonstrates the confidence that many surgeons have in the usefulness of clinical monitoring for early detection and intervention in the case of flap compromise. Some studies have shown that adjunctive techniques allow for greater success than clinical monitoring in terms of the clinically relevant outcome of flap salvage rate [12][13][14], but there are no larger scale trials supporting these studies. The paucity of high-level evidence for the use of expensive and sometimes invasive techniques has led to the widespread use of bedside monitoring, with some units using adjunctive techniques at the discretion of the surgeon [11,15].…”