Free flaps monitoring by Laser-Doppler Flowmetry in head and neck surgery

OBJECTIVE: Early recognition of free flap vascular impairment is essential for flap salvage attempts. Several methods for surveillance of post-operative flaps are available. Among these, we have extensively used Laser-Doppler Perfusion Flowmetry (LDF) monitoring. We report our experience on this topic and illustrate the advantages and weak points. METHODS: Over seven years, 110 consecutive free flaps for head and neck reconstruction were monitored using the Periflux System 5000(®) (Perimed AB, Järfälla, Sweden). In addition to maximum and minimum peaks, a pattern called vasomotion can be detected. Monitoring time lasted from 3 to 7 days, 24/24 h. RESULTS: Six of 110 (5.5%) cases of vascular problems were detected and clinically confirmed. In 5 cases, venous thrombosis was present: 4 patients were successfully treated. In 1 case, both arterial and venous thrombosis occurred. Flowmetry data always showed a more or less sudden disappearance of vasomotion. CONCLUSIONS: LDF is a highly sensible, specific and reliable method. It is easy to use and interpret at low cost. Remote monitoring could also be developed.