Comparison of Single Photon Emission Computed Tomography (SPECT) and implantable Doppler in the monitoring of a vascularised fibular free flap for reconstruction of the mandible
Research article published in The British journal of oral & maxillofacial surgery (2020)
Abstract
Monitoring of microvascular free flaps is an influencing factor in the success or failure of the treatment. In this study, we aim to compare the accuracy of implantable Doppler and scintigraphy in the monitoring of a vascularised buried fibular graft for reconstruction of the mandible. In a prospective cohort study, an implantable Doppler was placed intraoperatively, and Single Photon Emission Computed Tomography (SPECT) was taken in patients when abnormal blood flow was detected via the implantable Doppler or 48 hours after operations in patients with normal signals on the Doppler. The flaps were explored if patients did not have regular signals via implantable Doppler or if SPECT revealed impaired perfusion. The number of true- and false-positive cases and true- and false-negative cases were documented. Positive predictive value (PPV) and negative predictive value (NPV) were calculated. Eighteen (29%) of 62 patients underwent explorative surgery. The sensitivity of SPECT was 38.88%, and specificity was 97.72%. In SPECT, PPV was 87.50% and NPV 79.62%. The sensitivity of the implantable Doppler was 72.22%, and specificity was 93.08%. In assessment with the implantable Doppler, PPV was 81.25% and NPV 93.18%. It seems that SPECT and the implantable Doppler had sufficient specificity in the monitoring of a buried fibular graft. However, SPECT had a lower sensitivity than the implantable Doppler.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Among 62 patients with buried vascularised fibular mandibular grafts, SPECT and implantable Doppler both showed high specificity (97.72% and 93.08%), but SPECT sensitivity was lower (38.88% vs 72.22%), making Doppler better at detecting flap compromise.
Context
This prospective cohort study compared diagnostic accuracy of implantable Doppler versus SPECT imaging for monitoring vascularized fibular free flaps in mandibular reconstruction, enrolling 62 patients and reporting that the implantable Doppler had higher sensitivity (72.22% vs. 38.88%) while both modalities had high specificity. While leech therapy can be used for venous congestion salvage in free flaps, the article does not mention leeches, hirudotherapy, or leech-derived substances. The study focuses exclusively on postoperative flap perfusion monitoring technologies.
Citation
Reference (Vancouver style)
Tabrizi R, Okhovatpour MA, Hassani M, Rashad A. Comparison of Single Photon Emission Computed Tomography (SPECT) and implantable Doppler in the monitoring of a vascularised fibular free flap for reconstruction of the mandible. Br J Oral Maxillofac Surg. 2021;59(6):661-664. doi:10.1016/j.bjoms.2020.08.018. PMID: 34053800
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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