Clert V, Guédon C, Cristofari J-P, Halimi C, Barry B, Albert S
Service de chirurgie ORL et cervico-faciale, hôpital Bichat, GHU Paris Nord - Val de Seine, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
Ann Chir Plast Esthet. 2013 Apr;58(2):82-8. doi: 10.1016/j.anplas.2013.01.004. Epub 2013 Feb 8.
The use of free flaps in head and neck reconstructive surgery requires postoperative monitoring, usually by conventional clinical tests. Nevertheless, clinical testing is not applicable to buried free flaps that are more frequently used in the head and neck area. The purpose of this study was to describe the use and to evaluate the implantable doppler system in this setting.
Among 162 patients who underwent free flap reconstruction in our department, between June 2008 and October 2012, 23 patients had postoperative monitoring using implantable doppler system. Probe placement, monitoring parameters and postoperative course was analyzed.
Our series included 15 forearm free flaps, seven fibular flaps and one scapular flap. Indications for reconstruction were following the removal of a malignant tumor in 18 cases, a benign tumor in two cases and an osteoradionecrosis in three cases. Free flap monitoring by conventional clinical tests was not possible in 19 patients. Doppler signal was detected continuously during seven days in 82% of cases. A loss of signal was observed in three cases. Surgical exploration was required in one patient.
Implantable doppler for free flap monitoring is a safe, reliable and efficient technique and cost is reasonable. The use of implantable doppler system seems particularly useful in head and neck reconstruction for buried free flaps, which are not accessible to conventional clinical tests.
在头颈部重建手术中使用游离皮瓣需要术后监测，通常采用传统临床检查。然而，临床检查不适用于头颈部更常用的埋藏游离皮瓣。本研究的目的是描述可植入多普勒系统在此情况下的应用并对其进行评估。
2008年6月至2012年10月期间，在我科接受游离皮瓣重建手术的162例患者中，23例使用可植入多普勒系统进行术后监测。分析了探头放置、监测参数及术后病程。
我们的病例系列包括15例前臂游离皮瓣、7例腓骨皮瓣和1例肩胛皮瓣。重建指征为：18例为恶性肿瘤切除术后，2例为良性肿瘤切除术后，3例为放射性骨坏死。19例患者无法通过传统临床检查进行游离皮瓣监测。82%的病例在7天内持续检测到多普勒信号。3例观察到信号丢失。1例患者需要进行手术探查。
可植入多普勒用于游离皮瓣监测是一种安全、可靠且有效的技术，成本合理。可植入多普勒系统在头颈部重建中对于传统临床检查无法触及的埋藏游离皮瓣似乎特别有用。
