Original ArticlesTechniques of External Monitoring of Buried Free FlapsYuen, James C. MDAuthor Information From the Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. Received May 25, 2005 and accepted for publication, after revision, June 27, 2005. Reprints: James C. Yuen, MD, 4301 W. Markham, Slot 720, University of Arkansas for Medical Sciences, Little Rock, AR 72212. E-mail: [email protected]. Annals of Plastic Surgery: November 2005 - Volume 55 - Issue 5 - p 460-465 doi: 10.1097/01.sap.0000178810.41608.03 Buy Metrics AbstractIn Brief Postoperative monitoring of free tissue transfer has proven to be crucial in enhancing the flap salvage rate in the event of thrombosis of the anastomosed vessels. Unfortunately, for buried flaps in the head and neck, direct monitoring of the flap can be extremely difficult, if not impossible. Utilizing various methods of flap exposure in a series of 55 buried free flaps of the head and neck, we demonstrate that we were able to provide a reliable means of direct postoperative assessment of the free flaps. Exteriorized components (indicator flaps) were established for 52 cases. An incision to create a skin window in the neck for monitoring was used for 3 cases. For the exteriorized flaps, in addition to clinical observation, adjunctive continuous monitoring using laser Doppler flowmetry was employed for 4–5 days. One free flap developed vascular thrombosis, which was re-explored and salvaged, giving a flap success rate of 100%. Fifty of 52 (96.2%) external components remained viable and therefore reliable for monitoring the main body of the flap. Two indicator flaps were unreliable after postoperative day 1 due to poor skin perfusion, while the subcutaneous component clinically remained viable. There was no return to the operating room for false-positive reexploration. This series reinforces the feasibility and reliability of direct monitoring of buried free flaps using the laser Doppler in practically all cases when modification is added to the flap design and inset. Fifty-five consecutive buried free flaps for head and neck reconstruction were satisfactorily monitored by neck exteriorization of a portion of the flap or by creation of a skin window and use of the laser Doppler. © 2005 Lippincott Williams & Wilkins, Inc.