Plastic Surgery Research Council
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REVIEW OF OUTCOMES AFTER USE OF THE IMPLANTABLE COOK DOPPLER PROBE VERSUS THE SYNOVIS FLOW COUPLER FOR POST-OPERATIVE MONITORING OF FREE FLAP BREAST RECONSTRUCTION
Presenter: Grace Um
Co-Authors: Said HK; Colohan S; Neligan PC; Mathes DW
University of Washington Medical Center

Background: Despite advances in free flap breast reconstruction, venous thrombosis continues to be a cause of flap failure. Early detection of vessel compromise is critical. The Cook-Swartz implantable Doppler has been a tool for monitoring blood flow; however, implantation of the device is a separate procedure that requires additional operating time. Recently Synovis Life Technologies, introduced the Flow Coupler, which combines an end-to-end anastomotic coupler with a removable 20 MHz Doppler. This device allows the two procedures to be performed simultaneously with immediate confirmation of vessel patency. The authors studied the Synovis Flow Coupler in comparison to the more well-established Cook-Swartz Doppler for effectiveness and reliability in detection of vascular compromise.

Methods: In this retrospective study, the authors reviewed 220 free flap breast reconstructions in 150 patients over a 3-year period (2009 2012) in which either the Cook-Swartz Doppler or the Synovis Flow Coupler was implanted to monitor blood flow. Outcomes measured were accuracy by false-positive or false-negative rates; occurrences of take-back to the OR for flap salvage; and flap survival versus failure.

Results: In 109 reconstructions the Cook-Swartz Doppler was used, the false-positive rate was 1.0%, and the false-negative rate was 0%. Of the 11 flaps that required take-back (10.1%), one was due to clinical findings alone despite a good Doppler signal. The flap itself was compressed against a rib; no further revision of the microanastomosis needed. There were two cases of flap failure. Of the 111 reconstructions monitored using the Synovis Flow Coupler, the device had a false-positive rate of 1.9% and a false-negative rate of 0.0%. Five flaps required take-back (4.5%), 2 occurred in the same patient, and one of them eventually failed.

Conclusions: Our study reveals no statistically significant differences in outcomes for free flap breast reconstruction where either device was used. However, the Flow Coupler offers the advantage of a single procedure to both perform a venous anastomosis and to monitor venous flow.


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