Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Head and Neck Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
Laryngoscope. 2021 Jun;131(6):E1854-E1859. doi: 10.1002/lary.29247. Epub 2020 Nov 3.
OBJECTIVES/HYPOTHESIS: Free flap transfer offers a versatile option for reconstruction in head and neck surgery, with success rates over 95%. There remains a substantial re-exploration rate of roughly 5% to 15%, with early recognition of compromise essential to flap survival. Monitoring techniques are highly desirable, with the gold standard being clinical monitoring. The Cook-Swartz Doppler (CSD) probe utilizes Doppler technology to inform clinicians about real-time flow. We aim to describe our adoption of this technology in 100 consecutive free flaps.
Prospective case series.
Prospective data were collected from July 2014 to June 2015 on 100 consecutive free flaps performed at a head and neck unit in London, Ontario. All patients had a CSD inserted for arterial and venous monitoring.
A total of 100 free flaps were performed on 99 patients. Sensitivity was 87.1% and specificity was 85.7%. Positive predictive value was 98.8% and negative predictive value was 33.3%. False-negative and false-positive rate were 1.0% and 12.0%, respectively. The exploration rate was 12%, with no flap loss and two partial debridements. The CSD was helpful in management in 9% of cases and was clinically unhelpful in 11% of cases, with 10 of 11 abnormal signals ignored. There were three unique CSD complications; one retained wire, one pedicle laceration during extraction, and one clot around the probe interrupting signal.
The CSD is a helpful adjunct to clinical monitoring but has unique complications, which were not previously described. Pros and cons must be considered for new centers adopting this technology.
4 Laryngoscope, 131:E1854-E1859, 2021.
目的/假设：游离皮瓣移植为头颈部手术重建提供了一种多功能选择，成功率超过 95%。仍有约 5%至 15%的患者需要进行大量的再次探查，早期识别皮瓣受损对于皮瓣存活至关重要。监测技术非常重要，金标准是临床监测。Cook-Swartz 多普勒（CSD）探头利用多普勒技术向临床医生提供实时血流信息。我们旨在描述我们在 100 例连续游离皮瓣中采用该技术的情况。
前瞻性病例系列。
2014 年 7 月至 2015 年 6 月，在安大略省伦敦的一个头颈部外科病房对 100 例连续游离皮瓣进行了前瞻性数据收集。所有患者均插入 CSD 探头进行动脉和静脉监测。
99 例患者共进行了 100 例游离皮瓣手术。敏感性为 87.1%，特异性为 85.7%。阳性预测值为 98.8%，阴性预测值为 33.3%。假阴性和假阳性率分别为 1.0%和 12.0%。探查率为 12%，无皮瓣丢失，仅 2 例进行了部分清创术。CSD 在 9%的病例中有助于治疗，在 11%的病例中临床帮助不大，11 个异常信号中有 10 个被忽略。CSD 有 3 个独特的并发症；一个遗留的金属丝、一个在取出过程中切断蒂部的皮瓣和一个探头周围的血栓中断信号。
CSD 是临床监测的有益辅助手段，但具有独特的并发症，以前没有描述过。对于采用这项技术的新中心，必须权衡利弊。
4《喉镜》，131：E1854-E1859，2021 年。
