Combination of an Exteriorized Monitoring Flap and Hand-held Doppler for Simple and Reliable Monitoring of a Free Jejunal Graft Transfer in Hypopharyngeal Reconstruction Microsurgery

Abstract

We introduced a new, simple, reliable method for monitoring a free jejunal graft transfer by assessing visual signs and arterial blood flow in an exteriorized flap. In this retrospective study, all patients that underwent free jejunal graft transfers in hypopharyngeal reconstruction microsurgery between January 2013 and March 2020 were included. We monitored exteriorized flaps by assessing either visual signs only (n = 176) or both visual signs and arterial sound, detected using a hand-held Doppler (n = 164). Postoperative arterial insufficiency occurred in five flaps monitored with visual signs only. None of these flaps could be rescued. Postoperative arterial insufficiency occurred in four flaps monitored with both visual signs and a hand-held Doppler. Of these, two flaps were rescued. The new method led to satisfying results. The combination of visual signs and a hand-held Doppler provided a simple, reliable method for monitoring free jejunal graft transfers.

Keywords

• free jejunal graft transfer
• flap monitoring
• monitoring flap
• hand-held doppler
• vascular insufficiency
• head and neck microsurgical reconstruction