Abstract
Background Timely reexploration and reanastomoses can salvage failing free flaps. The use of
the implantable Doppler probe provides direct evidence of vascular impairment of the
microvascular anastomoses and allows for postoperative NPWT. The aim of this retrospective
study was to compare the Doppler probe to conventional monitoring techniques for free
flap monitoring in lower limb reconstruction and to identify risk factors for perfusion
disturbance and reexploration.
Methods All patients receiving free muscle flap reconstruction for lower limb soft tissue
defects at our department from 2000 to 2013 were included, and all adverse events,
timely detection of perfusion problems, and outcome of revision surgery were assessed
by chart analysis.
Results For lower limb reconstruction, 110 free muscle transfers were performed of which
41 muscle flaps were conventionally monitored and 69 flaps were monitored using the
implantable Doppler probe. In 18 cases, the free muscle flaps needed revision because
of perfusion disturbances. The salvage rate was 80% with monitoring by the implantable
Doppler probe compared with 62.5% using conventional monitoring methods resulting
in success rates of 95.7 and 92.7%, respectively.
Conclusion The use of the implantable Cook–Swartz Doppler probe represents a safe monitoring
method for lower limb reconstruction, which allows for the additional use of NPWT.
Higher salvage and revision success rates can be attributed to an earlier detection
of perfusion impairment. However, a larger patient cohort is necessary to verify superiority
over conventional postoperative monitoring.
Keywords
lower limb reconstruction - postoperative monitoring - implantable Doppler probe -
free muscle flap - microsurgery
