Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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The Venous Anastomotic Flow-Coupler for Free Flap Monitoring: A Prospective Analysis of 85 Microsurgical Breast Reconstruction Cases
Steve J. Kempton, M.D., Jenny Chen, MD, Samuel Poore, MD, Ahmed Afifi, MD.
University of Wisconsin-Madison Division of Plastic Surgery, Madison, WI, USA.

PURPOSE- The venous anastomotic flow-coupler has recently been developed for clinical use, contributing to a multitude of flap monitoring devices and techniques. To date, only one published small retrospective series (19 patients) reported this device to be both reliable and accurate for use in head and neck reconstruction; however, no data exists in the setting of abdominal based free flaps for breast reconstruction. The authors present a prospective analysis of the venous anastomotic flow coupler in 85 microsurgical breast reconstruction cases.
METHODS- Prospective data was collected on patients undergoing post-mastectomy free flap breast reconstruction from May 2012 to May 2013. Data obtained included patient age, BMI, flap type (DIEP, MS TRAM, SIEA), flow-coupler size, incidence of intraoperative and postoperative signal loss, anastomotic problems, coupler problems, flap take back, and flap failure. Proportion data was compiled and analyzed.
RESULTS- Eighty-five consecutive abdominal based free flaps for breast reconstruction were performed from May 2012 to May 2013 by two co-surgeons at the University of Wisconsin Hospital. The average patient age was 49.3 years and average BMI was 28.4. There were 53 MS-TRAM, 31 DIEP, and 1 SIEA flaps performed. The venous anastomotic flow coupler (FC) was used in all cases. The overall flap failure rate was 4.7% and flap take back rate was 7.1%. The flow-coupler was analyzed in both intraoperative and postoperative settings. Figure 1 and Figure 2 summarize the intraoperative and postoperative flow-coupler data respectively. Flap type and flow-coupler size were not found to be associated with flow-coupler problems. The intraoperative and postoperative sensitivity of the flow-coupler was found to be 100% (signal presence correlated well with flap viability). However, intraoperatively, the flow-coupler had a false positive rate of 75% and a positive predictive value of 0.25. Postoperatively, the flow-coupler had a 36% false positive rate and a positive predictive value of 0.64.
CONCLUSIONS- If the flow-coupler Doppler signal is audible, it becomes extremely fast, reliable, and efficient to confirm patency of a microsurgical anastomosis. However, there is a high false positive rate in both the intraoperative and postoperative setting. This led to a high incidence of intraoperative maneuvers to diagnose and amend the cause of signal loss. In 13% of cases, the flow-coupler Doppler signal was completely ignored and flaps were monitored more traditionally with external doppler or clinical exam.


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