Abstract
Aim
Multiple techniques exist to monitor free flap viability postoperatively, varying with practical and personal preference, yet the limitations of each technique remain unquantified. This systematic review aims to identify the most commonly reported limitations of these techniques in clinical practice.
Method
A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE and Web of Science with search criteria for postoperative free flap monitoring techniques. Search results were independently screened using defined criteria by two authors and a senior clinician. Limitations of the techniques found in the discussion section of eligible papers were recorded and categorised using recurrent theme analysis.
Results
A total of 4826 records were identified. 4643 articles met the eligibility criteria and were subsequently reviewed, with 195 papers included in the final analysis. The most frequently reported limitations of clinical monitoring were interpretation requiring expertise (25% of related papers), unsuitability for buried flaps (21%), and lack of quantitative/objective values (19%). For non-invasive technologies: lack of quantitative/objective values (21%), cost (16%) and interpretation requiring expertise (13%). For invasive technologies: application requiring expertise (25%), equipment design and malfunction (13%) and cost (13%).
Conclusions
This is the first systematic review to quantify the limitations of different flap monitoring techniques as reported in the literature. The limitations identified better inform clinicians to decide the best single or combined monitoring approach for their practice and aid development in new flap monitoring technologies.
A comparison of the Cook-Swartz Doppler with conventional clinical methods for free flap monitoring: A systematic review and a meta-analysis
