Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy, University of Melbourne, Grattan St, Parville, 3050, Victoria, Australia.
Microsurgery. 2010 Jul;30(5):354-60. doi: 10.1002/micr.20720.
Free flaps to the lower limb have inherently high venous pressures, potentially impairing flap viability, which may lead to limb amputation if flap failure ensues. Adequate monitoring of flap perfusion is thus essential, with timely detection of flap compromise able to potentiate flap salvage. While clinical monitoring has been popularized, recent use of the implantable Doppler probe has been used with success in other free flap settings.
A comparative study of 40 consecutive patients undergoing microvascular free flap reconstruction of lower limb defects was undertaken, with postoperative monitoring achieved with either clinical monitoring alone or the use of the Cook-Swartz implantable Doppler probe.
The use of the implantable Doppler probe was associated with salvage of 2/2 compromised flaps compared to salvage of 2/5 compromised flaps in the group undergoing clinical monitoring alone (salvage rate 100% vs. 40%, P = 0.28). While not statistically significant, this was a strong trend toward an improved flap salvage rate with the use of the implantable Doppler probe. There were no false positives or negatives in either group. One flap loss in the clinically monitored group resulted in limb amputation (the only amputation in the cohort).
A trend toward early detection and salvage of flaps with anastomotic insufficiency was seen with the use of the Cook-Swartz implantable Doppler probe. These findings suggest a possible benefit of this technique as a stand-alone or adjunctive tool in the clinical monitoring of free flaps, with further investigation warranted into the broader application of these devices.
下肢游离皮瓣的静脉压力较高，这可能会损害皮瓣的存活能力，如果皮瓣失活，可能导致肢体截肢。因此，对皮瓣灌注进行充分监测至关重要，及时发现皮瓣受损可提高皮瓣挽救的成功率。虽然临床监测已经得到普及，但最近在其他游离皮瓣环境中成功使用了植入式多普勒探头。
对 40 例连续接受下肢缺损微血管游离皮瓣重建的患者进行了一项对比研究，术后监测采用临床监测或 Cook-Swartz 植入式多普勒探头。
与单独进行临床监测的组中挽救 2/5 个受损皮瓣（挽救率 40%）相比，使用植入式多普勒探头可挽救 2/2 个受损皮瓣（挽救率 100%）（挽救率 100% vs. 40%，P = 0.28）。虽然没有统计学意义，但这表明使用植入式多普勒探头有改善皮瓣挽救率的趋势。在两组中均未出现假阳性或假阴性。在接受临床监测的组中，有 1 例皮瓣失活导致截肢（该队列中唯一的截肢）。
使用 Cook-Swartz 植入式多普勒探头可观察到吻合口不足的皮瓣早期检测和挽救的趋势。这些发现表明，该技术可能作为游离皮瓣临床监测的独立或辅助工具具有一定的益处，需要进一步研究这些设备的更广泛应用。
