Author(s)
Hilary Caitlyn McCrary MD, MPH
Mitch Dunklebarger MD
Brody King BS
Patrick Carpenter MD
Luke Buchmann MD
Jason Hunt MD
Richard B. Cannon MD
Affiliation(s)
University of Utah;
Abstract:
Introduction: The use of completely buried free flaps in head and neck surgery is controversial. Given the lack of a skin paddle, postoperative monitoring can be a challenge, but the use of implantable dopplers has improved monitoring of buried free flaps. The aim of this study is to describe the operative success of buried free flaps and to determine the safety/reliability of implantable dopplers.
Methods: A retrospective chart review from a single academic cancer hospital was conducted from 2014-2020. Only patients with a buried free flap without any visible skin paddle that had implantable dopplers placed were included. Charts were reviewed to determine flap viability after surgery, if there was a return to the operating room for vascular compromise, and if the doppler accurately detected change in free flap status.
Results: A total of 65 patients were included, of which 70.8% were male. The average age was 62 years. The locations of flaps included the following: pharynx 76.9%, skull base 7.7%, trachea 6.2%, esophagus 4.6%, and facial reanimation 4.6%. The types of free flaps performed included the following: radial forearm 50.8%, anterolateral thigh 44.6%, and gracilis 4.6%. One patient (1.5%) returned to the OR for vascular compromise, which was accurately detected on the implantable doppler and salvaged. 100% of free flaps in this series were found to be viable upon hospital discharge based on the implantable doppler signals. There were no complications related to implantable doppler use.
Conclusions: Implantable dopplers are safe and reliable in evaluating postoperative outcome of buried free flaps. With the use of implantable dopplers, buried free flap survival is markedly higher than traditionally thought, which allows for a cosmetically appealing and simplified reconstructive technique.