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Advancements in Free Flap Monitoring in the Last Decade: A Critical Review

Lin, Chih-Ming M.D.; Huang, Chieh-Chi M.D.; Hsu, Honda M.B.Ch.B.; Chiu, Chih-Hung M.D.; Chien, Sou-Hsin M.D.

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Plastic and Reconstructive Surgery: August 2010 - Volume 126 - Issue 2 - p 679
doi: 10.1097/PRS.0b013e3181df720b
  • Free


We read with great interest the article by Smit et al.1 We, at our center, perform approximately 260 free tissue transfers per year. We are fully aware of the numerous devices available for free flap monitoring. After using a few of the devices ourselves, we have found the conventional method of monitoring skin color to be the best method. The dilemma arises when the monitoring devices show a good signal but the flap appears compromised. At this stage, we are not sure what the authors would do, but we would perform exploration immediately. Thus, it all comes down to what the surgeon's eye sees. If the flap color appears compromised, we will return to the operating room, whether the monitoring device shows a good signal or not. We have our nurses monitor the flap hourly. If there is a change in color, the microsurgeon is called immediately. We have found that in this way it is “harmless to patient and flap, rapidly responsive, accurate, reliable, and applicable to all types of flap.” It is also the cheapest method available.

Chih-Ming Lin, M.D.

Chieh-Chi Huang, M.D.

Honda Hsu, M.B.Ch.B.

Chih-Hung Chiu, M.D.

Sou-Hsin Chien, M.D.

Division of Plastic Surgery

Dalin Tzu Chi General Hospital

Chia-Yi, Taiwan


1. Smit JM, Zeebregts CJ, Acosta R, Werker PM. Advancements in free flap monitoring in the last decade: A critical review. Plast Reconstr Surg. 2010;125:177–185.

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