ABSTRACT
The Cook-Swartz implantable Doppler probe (Cook Medical®, Cook Ireland Ltd., Limerick, Ireland) has evolved as a useful option for postoperative
free flap monitoring. For placement, the probe either is left unattached around the
venous pedicle or is secured. In our experience with over 300 applications, we typically
secure the cuff with two small microclips, or use fibrin glue. These techniques require
redundant silicone cuff for apposition; however, we have encountered some vessels
that are of sufficiently large diameter as to not provide enough cuff to employ these
methods. The first technique comprises the application of two interrupted sutures
through the cuff ends to mimic the technique of microclips. The sutures can be tightened
to the desired tension and can be used in cases where the cuff ends are not in direct
apposition. A second technique is to excise a segment of silicone cuff and either
clip or suture the excised segment to the cuff ends, effectively elongating the cuff
diameter. All four techniques (nonattachment, microclip fixation, suture fixation,
silicone cuff elongation) have been used effectively, and none have resulted in any
complications. Of note, the technique of nonattachment was associated with an increased
rate of false-positive results, as migration away from the vessel was postulated to
have occurred. There are a range of techniques for attachment of the implantable Doppler
probe, and each contributes to the range of options for cuff attachment in difficult
cases, with each technique worthwhile in particular settings.
KEYWORDS
Reconstruction - free flap - anastomosis - monitoring - postoperative
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Warren M RozenM.B.B.S. B.Med.Sc. P.G.Dip.Surg.Anat. Ph.D.
Department of Plastic and Reconstructive Surgery, Geelong Hospital
Bellerine Street, Victoria 3220, Australia
eMail: warrenrozen@hotmail.com