Objectives: Post-operative monitoring of microvascular free flaps is critical to the early detection and successful salvage of the compromised free flap. This task becomes more difficult in those situations involving buried and intra-oral vascularized flaps. The authors present their experience in maxillofacial reconstruction using a novel venous anastomotic coupling device combined with an internal microdoppler (Synovis Micro Companies Alliance Inc., Birmingham, Alabama).

Methods: Retrospective review of 19 consecutive free flaps for head and neck reconstruction from the OMFS databases (University of Maryland, Baltimore, MD and Legacy Emanuel Hopsital & Health Center, Portland, OR) with venous anastomoses performed and monitored using an implantable venous flow coupler from April 2010 through March 2011.

Results: A total of 20 implantable venous flow couplers were used in 19 consecutive free flaps. The fibula osteocutaneous flap was the most common free flap used ( n = 7). The facial vein was the most common recipient vein ( n = 9). Monitoring of the venous Doppler sound ranged from intra-operative until post-operative day 7 (mean 4.2 days). 18/20 flow coupler anastomoses produced an accurate sound. Two coupler lead wires were inadvertently pulled at the end of the surgeries. Two vessels required revision as a result of geometry or twisting. There were two coupler leads that were removed early in the post-operative course as a result of poor signal interpretation. All 19 flaps survived.

Conclusions: The combination of the fixed flow Doppler with the standard venous coupling ring appears to have added benefit in the monitoring of free vascularized flaps.

Conflict of interest: None declared.