Advances in Free Flap Monitoring: Have We Gone Too Far?

Purpose Of Review: Timely recognition of vascular compromise of free flaps is crucial to salvaging failing flaps. This review summarizes the most recent available literature about free flap monitoring over the period of 2008-2009. Novel techniques are discussed.

Recent Findings: Several case series have been published that highlight interesting methods for free flap monitoring; however, concerns of impracticality abound. The implantable Doppler has been used in a large case series with good success. Externalization of a flap component has undergone refinement in technique with success. Measurement of tissue oxygen tension and blood flow with PET is possible. Microendoscopy has been proposed as a possible technique for accessible flaps to assess capillary blood flow. Several retrospective studies elucidated trends in free flap compromise in the postoperative period, which confirm prior findings.

Summary: We provide an overview of recent techniques for free flap monitoring. No single technique provides an ideal method for free flap monitoring, but these methods may prove promising with future research and refinement. New techniques in free flap monitoring largely remain out of the scope of reasonable implementation.