Washington University School of Medicine, St. Louis, MO, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
J Plast Reconstr Aesthet Surg. 2014 Jul;67(7):960-6. doi: 10.1016/j.bjps.2014.03.034. Epub 2014 Apr 12.
The Cook-Swartz Doppler has long been a trusted tool for close monitoring of blood flow after microvascular reconstruction; however, device implantation requires additional operating time. Synovis Life Technologies, Inc. received FDA approval in 2010 for the Flow Coupler, which combines an end-to-end anastomotic coupler with a removable 20 MHz Doppler, allowing both procedures to be performed simultaneously. However, its short history of widespread use necessitates further evaluation in the clinical setting. The authors studied the Synovis Flow Coupler in comparison to the more well-established Cook-Swartz Doppler for effectiveness and reliability in detection of vascular compromise.
The authors reviewed 220 free flap breast reconstructions in 150 patients over a three-year period in which either the Cook-Swartz Doppler or the Synovis Flow Coupler was implanted to monitor blood flow. Outcomes measured include false-positive or false-negative rates (FPR, FNR); rates of OR take-back and salvage; and flap survival.
FPR was 1.0% for the Cook-Swartz Doppler and 1.9% for the Synovis Flow Coupler (p>0.05). FNR was 0.0% for both groups. Take-back rates were 10.1% for the Cook-Swartz, and 4.5% for Synovis (p>0.05). Flap failure rates were 1.8% and 0.9% for the Cook-Swartz and Synovis devices, respectively (p>0.05).
Our study reveals no statistically significant differences in outcomes for free flap breast reconstruction where either the Cook-Swartz Doppler or the Synovis Flow Coupler was used to monitor blood flow to the perforator flap.
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Cook-Swartz 多普勒超声仪长期以来一直是微血管重建后密切监测血流的可靠工具；然而，设备植入需要额外的手术时间。Synovis Life Technologies，Inc. 于 2010 年获得 FDA 批准，推出 Flow Coupler，它将端到端吻合连接器与可移动的 20MHz 多普勒结合在一起，使这两个程序可以同时进行。然而，它的广泛应用历史较短，需要在临床环境中进一步评估。作者研究了 Synovis Flow Coupler，与更为成熟的 Cook-Swartz 多普勒相比，评估其在检测血管阻塞方面的有效性和可靠性。
作者回顾了 150 名患者的 220 例游离皮瓣乳房重建手术，在这三年中，使用 Cook-Swartz 多普勒或 Synovis Flow Coupler 植入物监测血流。测量的结果包括假阳性或假阴性率（FPR、FNR）；手术室（OR）重新操作和抢救的比率；以及皮瓣存活。
Cook-Swartz 多普勒的 FPR 为 1.0%，Synovis Flow Coupler 的 FPR 为 1.9%（p>0.05）。两组的 FNR 均为 0.0%。Cook-Swartz 的重新操作率为 10.1%，Synovis 的重新操作率为 4.5%（p>0.05）。Cook-Swartz 和 Synovis 设备的皮瓣失败率分别为 1.8%和 0.9%（p>0.05）。
我们的研究表明，在使用 Cook-Swartz 多普勒或 Synovis Flow Coupler 监测穿支皮瓣血流的游离皮瓣乳房重建中，两种方法的结果没有统计学上的显著差异。
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