Laser Doppler flowmeter monitoring of free-tissue transfers: blood flow in normal and complicated cases.

In this article, laser Doppler flowmeter (LDF) monitoring of blood flow in 94 free flaps is summarized. Seventy-six patients had uneventful postoperative courses, and 18 patients developed postoperative complications, with a salvage rate of 88 percent. Except for one case, the flowmeter identified developing complications before clear clinical indices appeared, and in two cases it was the only indication of vascular compromise of the flap. On the basis of the data obtained, the ranges of absolute flow values in different types of uncomplicated flaps are reported, along with their temporal pattern of flow. Decrease inflow pattern may be an early indicator of a developing perfusion disturbance. On the basis of LDF readings, the following classifications of free-flap blood flow are suggested. (1) If the flow is within or slightly above the established range, then normal diligence in observation is justified. If the flow is well above the normal range, artifacts that could falsely elevate readings should be investigated. (2) If the flow is somewhat below the established range, then a modest increase in observation is warranted (alert level 1). (3) If the relative flow falls to 50 percent of the initial flow of that flap and remains at that level for 30 minutes or longer, then more aggressive flap observation is indicated (alert level 2). (4) If the flow is below 0.4 LDF units for 30 minutes, then aggressive clinical observation should be performed (alert level 3, or "red alert") and exploration should be strongly considered. Falsely elevated measurements can be caused by vibration, motion of the probe or tissue, or location of the probe over a macroscopic blood vessel. False low readings are quite rare but can result from partial probe detachment from the flap or coagulum accumulating on the probe. Once artifacts are ruled out, LDF readings have a high level of credibility and, in the authors' experience, significantly improve salvage rates.