Postoperative blood flow monitoring of free transferred tissue after reconstruction of head and neck cancer surgery is important. We retrospectively analyzed the accuracy of postoperative clinical flap monitoring after head and neck reconstruction.
Our clinical assessment of postoperative blood flow of transferred tissue involved evaluation of flap appearance, capillary refill, warmness, and the pin prick test. During October 2004 to May 2008, 544 free flaps with skin islands were transferred in 520 patients. Of these, twelve patients who had suspected blood flow insufficiency were evaluated.
The appearance of 12 flaps was congestive in 7 and pale in 5 cases. Seven congestive flaps revealed venous thrombosis in 4 cases, perforator trouble in 2 cases, and one case was false positive. Five pale flaps showed arterial thrombosis in 4 cases and a kinked pedicle in one case. Vascular re-anastomosis could be carried out in 5 cases and the salvage rate was 27.3%. The total flap success rate was 98.5%. The sensitivity of our clinical assessment procedure was 100% and the false positive rate was 0.2%.
Although our clinical assessment showed a slightly poor salvage rate, a satisfactory sensitivity and specificity were obtained compared with other postoperative blood flow monitoring methods. Based on these outcomes, our clinical method is safe, easy and appropriate to assess the state of postoperative free flaps.
