Journal of Reconstructive Microsurgery Open 2016; 01(02): 073-081
DOI: 10.1055/s-0036-1585086
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Efficacy of the Cook–Swartz Implantable Doppler in the Detection of Free-Flap Compromise: A Systematic Review and Meta-Analysis

Riaz A. Agha
1  Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
Buket Gundogan
2  University College London Medical School, London, United Kingdom
Alexander J. Fowler
3  Department of Vascular Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
Thomas W. H. Bragg
4  Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, Bucks, United Kingdom
Dennis P. Orgill
5  Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

22 February 2016

26 May 2016

Publication Date:
02 September 2016 (online)



Background Reducing free-flap failure rates is a key goal of any microsurgical unit. The Cook–Swartz implantable Doppler (CSD) can be used to monitor flap vascularity. We conducted a systematic review and meta-analysis to compare the efficacy of the CSD with clinical monitoring to prevent flap failure.

Methods A comprehensive literature search was performed using MEDLINE, EMBASE, PsycINFO, EBSCO, the Cochrane Library, CINAHL, SCOPUS, SciELO, NHS evidence, and online clinical trial registers from 1966 until December 31, 2015. Studies comparing flap failure rates in the CSD and clinically monitored groups were considered. Screening and data extraction was performed by two independent researchers.

Results Overall, eight articles met the inclusion criteria, involving 3,756 patients and 3,801 flaps. The average failure rate in the clinical group was 3.5% and in the Doppler group was 2.0%. A fixed effects meta-analysis was performed and found a reduced failure rate with the use of the CSD (odds ratio= 0.37 [0.21–0.64], p = 0.0005).

Conclusion Deployment of the CSD can lower flap failure rates and has the potential to be a useful adjunct to clinical monitoring of free flaps. Further research is needed to confirm its benefits and refine its indications to optimize cost-effectiveness.