Teven Chad M, Ooi Adrian S H, Inbal Amir, Chang David W
Section of Plastic and Reconstructive Surgery, The University of Chicago Medicine, Chicago, Illinois.
J Surg Oncol. 2017 Sep;116(3):371-377. doi: 10.1002/jso.24655. Epub 2017 Apr 25.
Reliable flap monitoring is crucial to the success of free tissue transfer, including vascularized lymph node transfer (VLNT). However, no large-scale study has examined implantable Doppler monitoring in VLNT. We aimed to determine whether an implantable Doppler system can reliably monitor flap perfusion during VLNT and also to calculate the sensitivity and specificity of this system for detecting compromise in the monitored vessel.
An analysis of prospectively collected data of patients who underwent buried VLNT with implantable Doppler monitoring between 2014 and 2015 was performed.
A consecutive series of 100 patients underwent VLNT with implantable Doppler monitoring. Five cases required return to the operating room for flap exploration due to a change in Doppler signal quality. All compromised flaps were salvaged. The sensitivity of the implantable Doppler system for flap monitoring was 100%, the specificity was 97.9%, the positive predictive value was 60%, and the negative predictive value was 100%. The false-positive rate was 2%.
This is the largest reported series of implantable Doppler monitoring of free flap perfusion during VLNT. Our experience suggests that this is a safe and effective technique for postoperative monitoring of VLNT.
可靠的皮瓣监测对于游离组织移植（包括带血管蒂淋巴结移植，VLNT）的成功至关重要。然而，尚无大规模研究探讨可植入式多普勒监测在VLNT中的应用。我们旨在确定可植入式多普勒系统能否在VLNT期间可靠地监测皮瓣灌注，并计算该系统检测被监测血管受损情况的敏感性和特异性。
对2014年至2015年间接受带植入式多普勒监测的埋置式VLNT患者的前瞻性收集数据进行分析。
连续100例患者接受了带植入式多普勒监测的VLNT。5例因多普勒信号质量改变需返回手术室进行皮瓣探查。所有受损皮瓣均成功挽救。可植入式多普勒系统用于皮瓣监测的敏感性为100%，特异性为97.9%，阳性预测值为60%，阴性预测值为100%。假阳性率为2%。
这是报道的关于VLNT期间游离皮瓣灌注的可植入式多普勒监测的最大系列研究。我们的经验表明，这是一种用于VLNT术后监测的安全有效的技术。
