Bedside Neck Exploration for Venous Flow Coupler Signal Loss in Postoperative Free Tissue Transfer Monitoring

Otolaryngol Head Neck Surg. 2022 Aug;167(2):242-247. doi: 10.1177/01945998211052938. Epub 2021 Oct 26.

Abstract

Objective: To describe the role and efficacy of bedside neck exploration following free tissue transfer.

Study design: Retrospective case series.

Setting: Single tertiary care institution.

Methods: A retrospective chart review was conducted of 353 patients who underwent free tissue transfer between January 2017 and April 2021. Bedside exploration was performed under mild sedation in patients who had loss of venous Doppler signal with equivocal clinical signs of venous insufficiency.

Results: A total of 11 patients underwent bedside assessment of the microvascular pedicle. In 6 cases, a return to the operating room was avoided. Five of these patients had coupler malfunction, and in 1 patient a venous kink was discovered and remedied at the bedside. Five patients required return to the operating room. Venous thrombosis requiring thrombectomy and revision of the venous anastomosis was discovered in 3 patients. One patient had a developing hematoma necessitating evacuation in the operating room, and 1 returned to the operating room due to sternocleidomastoid muscular compression of the venous pedicle. There were no flap failures within the study group. In all cases, broad-spectrum intravenous antibiotic coverage was prophylactically used, and no instances of wound infection were observed. Avoidance of returning to the operating room prevented an estimated $9222 of hospital charges per event.

Conclusion: Bedside neck exploration can be incorporated as a safe and cost-effective intermediary for definitive determination of need for return to the operating room.

Keywords: bedside exploration; flow coupler; free flap; monitoring.

MeSH terms

  • Anastomosis, Surgical
  • Free Tissue Flaps* / blood supply
  • Humans
  • Microsurgery
  • Postoperative Complications / diagnosis
  • Reconstructive Surgical Procedures*
  • Retrospective Studies
  • Venous Thrombosis* / surgery