Department of Plastic and Reconstructive Surgery, Geelong Hospital, Bellerine Street, Victoria, Australia.
J Reconstr Microsurg. 2011 Feb;27(2):99-102. doi: 10.1055/s-0030-1267837. Epub 2010 Oct 13.
The Cook-Swartz implantable Doppler probe (Cook Medical(®), Cook Ireland Ltd., Limerick, Ireland) has evolved as a useful option for postoperative free flap monitoring. For placement, the probe either is left unattached around the venous pedicle or is secured. In our experience with over 300 applications, we typically secure the cuff with two small microclips, or use fibrin glue. These techniques require redundant silicone cuff for apposition; however, we have encountered some vessels that are of sufficiently large diameter as to not provide enough cuff to employ these methods. The first technique comprises the application of two interrupted sutures through the cuff ends to mimic the technique of microclips. The sutures can be tightened to the desired tension and can be used in cases where the cuff ends are not in direct apposition. A second technique is to excise a segment of silicone cuff and either clip or suture the excised segment to the cuff ends, effectively elongating the cuff diameter. All four techniques (nonattachment, microclip fixation, suture fixation, silicone cuff elongation) have been used effectively, and none have resulted in any complications. Of note, the technique of nonattachment was associated with an increased rate of false-positive results, as migration away from the vessel was postulated to have occurred. There are a range of techniques for attachment of the implantable Doppler probe, and each contributes to the range of options for cuff attachment in difficult cases, with each technique worthwhile in particular settings.
库克-斯沃茨（Cook Medical(®)，Cook Ireland Ltd.，利默里克，爱尔兰）植入式多普勒探头已成为术后游离皮瓣监测的一种有用选择。对于探头的放置，可以将其环绕静脉蒂而不固定，也可以将其固定。在我们超过 300 次应用的经验中，我们通常使用两个小微型夹或纤维蛋白胶来固定袖口。这些技术需要冗余的硅酮袖口来贴合；然而，我们遇到了一些血管直径足够大，以至于无法提供足够的袖口来使用这些方法。第一种技术包括通过袖口末端应用两个间断缝线，以模拟微型夹的技术。缝线可以收紧到所需的张力，并且可以用于袖口末端没有直接贴合的情况。第二种技术是切除一段硅酮袖口，并将切除的部分夹或缝合到袖口末端，有效地延长袖口直径。所有四种技术（不固定、微型夹固定、缝线固定、硅酮袖口延长）都已被有效地应用，并且都没有导致任何并发症。值得注意的是，不固定的技术与更高的假阳性结果率相关，因为推测袖口已经从血管处迁移。有一系列的植入式多普勒探头固定技术，每种技术都有助于在困难情况下的袖口固定的选择范围，每种技术在特定情况下都有价值。
