Recent advances in postoperative free microvascular flap monitoring

SummaryMicrovascular free flap surgery is one of the most important operations in reconstructive surgery. With the advancement of microsurgical technique, the success rate of free flap pedicle anastomosis is now >90%. The key to further enhance the free flap success rate is early detection of vascular thrombosis and salvaging of the failing flap with early intervention. The gold standard of postoperative free flap monitoring is clinical observation of flap color and capillary refill; however, it is subjective and observer-dependent. Many objective methods have been developed for accurate and early detection of flap pedicle thrombosis. Recent advances in flap monitoring methods have been reviewed including implantable Doppler system, surface temperature monitoring, near infrared spectroscopy, and telemedicine. The ideal postoperative monitoring method for free flap surgery should meet the following requirements: it should be noninvasive, reliable, accurate, inexpensive, and easy to use even for inexperienced personnel, and it should provide real-time information. Although many new methods have been developed, no single monitoring technique has fulfilled all these requirements.