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Evidence for Postoperative Monitoring of Microvascular Free Flaps: A Systematic Review.
MedLine Citation:
PMID:  23038130     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Postoperative monitoring of the microcirculation of free flaps continues to pose a challenge in the 21st century. Voluminous literature has been written on this subject in the past 3 decades, but there are few articles that directly address clinically relevant end points, such as the salvage rates of compromised flaps that are being monitored. METHODS: The current evidence regarding the postoperative monitoring of microvascular free-tissue transfer was investigated with an extensive electronic and manual search. The included literature (N = 114 publications) was critically evaluated based on the March 2009 Oxford Centre for Evidence-Based Medicine definitions, focusing on the evidence for the efficacy of each technique in improving the flap salvage rate of compromised flaps. RESULTS: There is a paucity of outcome-based studies, with only laser Doppler flowmetry, fluorometry, and the implantable Doppler probe having been shown in comparative studies to affect the flap salvage rate. Currently, the implantable Doppler probe is the method with the largest number of comparative studies and case series to demonstrate its effectiveness compared with clinical monitoring. CONCLUSION: There is a need for further research on most proposed techniques with a focus on clinically relevant outcomes, and not simple clinical series reporting patient and physician satisfaction.
Authors:
Daniel Chubb; Iain S Whitaker; Warren M Rozen; Damien Grinsell; Mark W Ashton; William C Lineaweaver
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-3
Journal Detail:
Title:  Annals of plastic surgery     Volume:  -     ISSN:  1536-3708     ISO Abbreviation:  Ann Plast Surg     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7805336     Medline TA:  Ann Plast Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the *Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy, University of Melbourne, Parkville, Victoria, Australia; †Department of Plastic, Reconstructive and Burns Surgery, The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom; and ‡Rankin Plastic Surgery Centre, Brandon, MS.
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