A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry.
Case report published in Journal of reconstructive microsurgery (2012)
Abstract
No universally accepted method of flap monitoring exists, and several techniques are in use. Repeated physical examination is most popular and is often supplemented with a handheld, external Doppler, and/or implantable Doppler probes; near-infrared spectroscopy is less commonly used. We investigated the nursing and resident house staff's experience and confidence with physical exam for flap monitoring. Also, a consecutive series of 38 patients with free flaps were monitored using physical examination, external Doppler, implantable arterial and venous Doppler probes, and near-infrared spectroscopy. Five patients developed signs of microvascular complications within 3 days of surgery; all were explored and salvaged. Neither the residents nor the nursing staff were universally trained or experienced in flap monitoring by physical exam. In all patients, changes in the appearance of the flap suggestive of a microvascular complication lagged 30 to 60 minutes after the adjunctive monitoring methods indicated that a problem had occurred. Near-infrared spectroscopy was the first warning sign in four of the five patients. Two patients were explored before thrombosis of the anastomoses occurred. Near-infrared spectroscopy may identify early microvascular complications more reliably than physical examination, external Doppler, or implantable Doppler.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
No universally accepted method of flap monitoring exists, and several techniques are in use. Repeated physical examination is most popular and is often supplemented with a handheld, external Doppler, and/or implantable Doppler probes; near-infrared spectroscopy is less commonly used.
Por qué esto importa para la hirudoterapia
Este estudio investigó la experiencia y la confianza del personal de enfermería y residentes con el examen físico para la monitorización de colgajos, y monitorizó una serie consecutiva de 38 pacientes con colgajos libres mediante examen físico, Doppler externo, sondas Doppler arteriales y venosas implantables, y espectroscopia de infrarrojo cercano. Los cambios en el examen físico sugerentes de complicación microvascular se retrasaron 30–60 minutos respecto a los métodos de monitorización complementarios, y la espectroscopia de infrarrojo cercano fue el primer signo de alerta en cuatro de cinco pacientes con complicaciones. Esto es relevante para el contexto clínico más amplio de la vigilancia postoperatoria de colgajos, donde el compromiso vascular debe detectarse con prontitud. Sin embargo, el resumen no menciona las sanguijuelas ni la hirudoterapia en ningún momento, por lo que cualquier conexión con el ámbito de ASH es solo indirecta e inferencial, limitada al marco compartido de la monitorización vascular de colgajos y no a ninguna intervención relacionada con sanguijuelas.
Citación
A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry.
Lohman et al. · Journal of reconstructive microsurgery, 2012
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026