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Do Adjunctive Flap-Monitoring Technologies Impact Clinical Decision Making? An Analysis of Microsurgeon Preferences and Behavior by Body Region

Bellamy, Justin L. M.D.; Mundinger, Gerhard S. M.D.; Flores, José M. M.P.H.; Wimmers, Eric G. M.D.; Yalanis, Georgia C. M.Sc.; Rodriguez, Eduardo D. M.D., D.D.S.; Sacks, Justin M. M.D.

Plastic and Reconstructive Surgery: March 2015 - Volume 135 - Issue 3 - p 883–892
doi: 10.1097/PRS.0000000000001064
Reconstructive: Trunk: Special Topics

Background: Multiple perfusion assessment technologies exist to identify compromised microvascular free flaps. The effectiveness, operability, and cost of each technology vary. The authors investigated surgeon preference and clinical behavior with several perfusion assessment technologies.

Methods: A questionnaire was sent to members of the American Society for Reconstructive Microsurgery concerning perceptions and frequency of use of several technologies in varied clinical situations. Demographic information was also collected. Adjusted odds ratios were calculated using multinomial logistic regression accounting for clustering of similar practices within institutions/regions.

Results: The questionnaire was completed by 157 of 389 participants (40.4 percent response rate). Handheld Doppler was the most commonly preferred free flap-monitoring technology (56.1 percent), followed by implantable Doppler (22.9 percent) and cutaneous tissue oximetry (16.6 percent). Surgeons were significantly more likely to opt for immediate take-back to the operating room when presented with a concerning tissue oximetry readout compared with a concerning handheld Doppler signal (OR, 2.82; p < 0.01), whereas other technologies did not significantly alter postoperative management more than simple handheld Doppler. Clinical decision making did not significantly differ by demographics, training, or practice setup.

Conclusions: Although most surgeons still prefer to use standard handheld Doppler for free flap assessment, respondents were significantly more likely to opt for immediate return to the operating room for a concerning tissue oximetry reading than an abnormal Doppler signal. This suggests that tissue oximetry may have the greatest impact on clinical decision making in the postoperative period.

Baltimore, Md.; and New York, N.Y.

From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; and the Department of Plastic and Reconstructive Surgery, New York University School of Medicine.

Received for publication May 29, 2014; accepted September 15, 2014.

Disclosure: Dr. Sacks is a speaker and consultant for LifeCell Corp. The authors have no financial interest to declare in relation to the content of this article.

Justin M. Sacks, M.D., Department of Plastic and Reconstructive Surgery, Johns Hopkins Outpatient Center, Suite 2114C, Baltimore, Md. 21287,

©2015American Society of Plastic Surgeons