Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis

Tzu-Yen Chang, Yao-Chou Lee, You-Cheng Lin, Stanley Thian-Sze Wong, Yuan-Yu Hsueh, Yao-Lung Kuo, Shyh-Jou Shieh, Jing-Wei Lee, Tzu-Yen Chang, Yao-Chou Lee, You-Cheng Lin, Stanley Thian-Sze Wong, Yuan-Yu Hsueh, Yao-Lung Kuo, Shyh-Jou Shieh, Jing-Wei Lee

Abstract

Background: Although clinical assessment remains the gold standard for monitoring the circulation of free flaps, several adjunct techniques promote timely salvage by detecting circulation compromise early. The objective of this systematic review was to evaluate the efficacy of an implantable Doppler probe for postoperatively monitoring free flaps.

Materials and methods: English-language articles evaluating the efficacy of implantable Doppler probes compared with clinical assessment for postoperatively monitoring free flaps were analyzed. The outcome measures were total flap failure rates, salvage rates, sensitivity, false-positive rates, and positive likelihood ratios.

Results: Of the 504 citations identified, 6 comparative studies were included for meta-analysis. An implantable Doppler probe significantly lowered the flap failure rate (risk ratio: 0.40; 95% confidence interval: 0.21-0.75) and raised the successful salvage rate (risk ratio: 1.73; 95% confidence interval: 1.16-2.59). Pooled sensitivity was higher (1.00 vs 0.98), the positive likelihood ratio was lower (72.16 vs 220.48), and the false-positive rate was higher (0.01 vs 0) in the implantable Doppler probe group than in the clinical assessment group.

Conclusion: An implantable Doppler probe is significantly more efficacious than clinical assessment for postoperatively monitoring free flaps.

Figures

Fig. 1.
Fig. 1.
Study attrition diagram.
Fig. 2.
Fig. 2.
Forest plots comparing the potential benefits for the flap failure rate when using the implantable Doppler probe and the traditional clinical assessment method. The implantable Doppler probe group had a significantly lower flap failure rate (A). The failure rate was still significantly lower after Ferguson and Yu, the pure buried flap study had been removed (B), and after Kind et al, a study of moderate quality (NOS of 5 or 6) had also been removed (C).
Fig. 3.
Fig. 3.
Forest plots evaluating the potential benefits for the flap salvage rate of using the implantable Doppler probe and the traditional clinical assessment method. The implantable Doppler probe group had a significantly higher flap salvage rate (A). The salvage rate was still significantly higher after Kind et al; a study of moderate quality (NOS of 5 or 6) had been removed (B).
Fig. 4.
Fig. 4.
Forest plots comparing the sensitivity of the implantable Doppler probe group and the clinical assessment group. The pooled sensitivity was higher in the Doppler probe group (100%) (A) than in the clinical assessment group (98%) (B).
Fig. 5.
Fig. 5.
Forest plots comparing the positive LR between the implantable Doppler probe group and the clinical assessment group. The positive LR was significantly lower in the Doppler probe group (72.16) (A) than in the clinical assessment group (220.48) (B).

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