Author(s)
Emily Sagalow, BS
1
Ramez Philips, MD
1
Farshid Taghizadeh, BSc
2
Richard Goldman, MD
1
Adam Luginbuhl, MD
1
Larissa Sweeny, MD
3
Mark K. Wax, MD
2
Joseph M. Curry, MD
1
Affiliation(s)
1Department of Otolaryngology – Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,
2Oregon Health & Science University Hospital, Portland, Oregon,3Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana;
Abstract:
Educational Objective: To understand the effect of different free flap monitoring techniques on flap salvage and survival.
Objectives: This study aims to compare flap survival and salvage rate between either implantable Doppler, near infrared spectroscopy (NIRS), or microdialysis and conventional clinical exam.
Study Design: Systematic review and meta-analysis.
Methods: Medline, Google Scholar, and Cochrane databases were queried. Included studies compared flap survival and salvage rate between either implanted Doppler, microdialysis, and/or NIRS with clinical monitoring with or without external doppler. Studies that compared modalities within one flap were excluded. A forest plot was plotted via inverse variance weighting, random effects model, and odds ratio for effect size.
Results: The search yielded 15 articles that met all inclusion criteria. A total of 6,619 patients were included in the analysis. Implantable Doppler was associated with significantly higher flap salvage rate but similar overall flap survival rates when compared to conventional methods (9 studies, p=0.003 and p=0.32, respectively). When compared to flap monitoring with external Doppler, implantable Doppler was associated with significantly higher flap salvage and overall survival rates (4 studies, p=0.04 and p=0.02, respectively). NIRS was associated with higher significantly higher flap salvage and overall survival rates when compared to conventional methods (4 studies, p=0.003, p=0.01, respectively). Microdialysis did not differ from conventional methods in terms of flap salvage and overall survival (2 studies, p=0.48 and p=0.27, respectively).
Conclusions: These findings suggest implanted Dopplers and NIRS are favorable flap monitoring modalities compared to conventional methods.