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J Reconstr Microsurg 2010; 26(6): 409-416
DOI: 10.1055/s-0030-1249607
© Thieme Medical Publishers

Postoperative Monitoring of Free Flaps in Autologous Breast Reconstruction: A Multicenter Comparison of 398 Flaps Using Clinical Monitoring, Microdialysis, and the Implantable Doppler Probe

Iain S. Whitaker1 , Warren M. Rozen2 , Daniel Chubb1 , Rafael Acosta1 , Birgitte J. Kiil3 , Hanne Birke-Sorensen3 , Damien Grinsell1 , Mark W. Ashton2
  • 1Department of Plastic Surgery, Uppsala University Hospital, Uppsala, Sweden
  • 2Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy, University of Melbourne, Victoria, Australia
  • 3Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark
Further Information

Publication History

Publication Date:
10 March 2010 (online)

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ABSTRACT

Many techniques for flap monitoring following free tissue transfer have been described; however, there is little evidence that any of these techniques allow for greater rates of flap salvage over clinical monitoring alone. We sought to compare three established monitoring techniques across three experienced microsurgical centers in a comparable cohort of patients. A retrospective, matched cohort study of 398 consecutive free flaps in 347 patients undergoing autologous breast reconstruction was undertaken across three institutions during the same 3-year period, with a single form of postoperative monitoring used at each institution: clinical monitoring alone, the Cook-Swartz implantable Doppler probe, or microdialysis. Both objective and subjective measures of efficacy were assessed. Clinical monitoring alone, the implantable Doppler probe, and microdialysis showed statistically similar rates of flap salvage. False-negative rates were also statistically similar (only seen in the clinically monitored group). However, there was a statistically significant increase in false-positive alarms causing needless take-backs to theater in the microdialysis and implantable Doppler arms, p < 0.001. This study did not find any technique superior to clinical monitoring alone. New monitoring technologies should be compared objectively with clinical monitoring as the current standard in postoperative flap monitoring.

KEYWORDS

Breast reconstruction - deep inferior epigastric artery - DIEP flap - perforator flap - superficial inferior epigastric artery perforator flap - Cook probe

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Warren M RozenM.B.B.S. B.Med.Sc. P.G.Dip.Surg.Anat. Ph.D. 

Jack Brockhoff Reconstructive Plastic Surgery Research Unit

Room E533, Department of Anatomy, University of Melbourne, Grattan St, Parkville, 3050, Victoria, Australia

Email: warrenrozen@hotmail.com

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