Eight-year experience of the Cook-Swartz Doppler in free-flap operations: microsurgical and reexploration results with regard to a wide spectrum of surgeries.

BACKGROUND: Microvascular free flap has become an increasingly popular useful method of reconstruction over the past few decades. Minimizing failure rates in these operations is a primary goal in every microsurgical unit that can be accomplished by early recognition.
METHODS: In this retrospective study, we tracked the admission of the implantable Doppler in the microsurgical unit (2000-2007) and evaluated parameters measured from 473 consecutive patients who underwent a total of 548 microsurgical procedures (489 primary surgeries and 59 reexplorations). The effectiveness of the Cook-Swartz Doppler (Cook Medical®) was examined in juxtapose general and subspecialty's aspects: in each microsurgical subspecialty, we compared the overall success and failure rates of the group with the implantable Doppler (n = 259) with the control group monitored by clinical means (n = 289). We also examined the duration, outcomes, and the effectiveness of this device in reexploration operations.
RESULTS: Overall, success rates were improved by using the implantable Doppler contrary to clinical assessment (96.14% vs. 89.27%) with a statistical significant (P < 0.005). The device was most effective in ENT (94.6% vs. 84%), breast reconstructive surgeries (97.3% vs. 82.36%), and orthopedic oncology (97.37% vs. 83.72%), whereas with reanimation operations and trauma/orthopedics subspecialties, it showed no necessity. In neurosurgery and in other/esthetic surgeries, the study was too small to draw definite deductions.
CONCLUSIONS: We recommend the usage of the implantable Doppler probe as an effective monitoring system for free-flap surgeries, with emphasis on subspecialties where the device demonstrated better results than traditional monitoring methods.