Implantable arterial doppler efficacy in free flap reconstruction: A systematic review and meta-analysis

Kevin G. Wu; Christian T. Chong; Hunter Hanlon; Tyler L. Langenfeld; R. Michael Johnson; Timothy N. Crawford; Mark K. Wax; Sameep P. Kadakia

doi:10.1002/hed.27500

Implantable arterial doppler efficacy in free flap reconstruction: A systematic review and meta-analysis

Kevin G. Wu, Christian T. Chong, Hunter Hanlon, Tyler L. Langenfeld, R. Michael Johnson, Timothy N. Crawford, Mark K. Wax, Sameep P. Kadakia

Research output: Contribution to journal › Review article › peer-review

Abstract

The implantable arterial doppler (IAD) is frequently used to postoperatively monitor free flaps with high accuracy, but there are no guidelines for its use. Bedside exam is used adjunctively to determine necessary intervention. This systematic review seeks to discover why the doppler is used adjunctively despite its established record of accuracy. Criteria for inclusion and exclusion were established. In total, 280 articles were found on PubMed and Web of Science, then screened accordingly. Data from 22 articles were analyzed using a bivariate hierarchical random effects model. Twenty-two studies yielded 2996 total patients undergoing 3127 free flap procedures. The meta-analysis found a high sensitivity of 0.809 (95% CI = 0.709, 0.880) and specificity of 0.966 (95% CI = 0.947, 0.979). False-positive rate was found to be 0.034 (95% CI = 0.021, 0.053). Positive and negative predictive values were 0.711 (95% CI = 0.581, 0.817) and 0.979 (95% CI = 0.966, 0.988). Positive and negative likelihood ratios were 24.7 (95% CI = 14.5, 39.5) and 0.20 (95% CI = 0.12, 0.30). The established efficacy of the IAD is supported by this study. Clinical exams may remain as the final adjunct due to the risks of inaccurate IAD signals. Further studies are warranted to optimize its use for future practice guidelines.

Original language	English (US)
Pages (from-to)	2710-2717
Number of pages	8
Journal	Head and Neck
Volume	45
Issue number	10
DOIs	https://doi.org/10.1002/hed.27500
State	Published - Oct 2023

Keywords

flap monitoring
free flap
implantable doppler
microvascular surgery
systematic review

ASJC Scopus subject areas

Otorhinolaryngology

Access to Document

10.1002/hed.27500

Cite this

@article{65657827e1bb4d8d8a4ba51632bd9f57,

title = "Implantable arterial doppler efficacy in free flap reconstruction: A systematic review and meta-analysis",

abstract = "The implantable arterial doppler (IAD) is frequently used to postoperatively monitor free flaps with high accuracy, but there are no guidelines for its use. Bedside exam is used adjunctively to determine necessary intervention. This systematic review seeks to discover why the doppler is used adjunctively despite its established record of accuracy. Criteria for inclusion and exclusion were established. In total, 280 articles were found on PubMed and Web of Science, then screened accordingly. Data from 22 articles were analyzed using a bivariate hierarchical random effects model. Twenty-two studies yielded 2996 total patients undergoing 3127 free flap procedures. The meta-analysis found a high sensitivity of 0.809 (95% CI = 0.709, 0.880) and specificity of 0.966 (95% CI = 0.947, 0.979). False-positive rate was found to be 0.034 (95% CI = 0.021, 0.053). Positive and negative predictive values were 0.711 (95% CI = 0.581, 0.817) and 0.979 (95% CI = 0.966, 0.988). Positive and negative likelihood ratios were 24.7 (95% CI = 14.5, 39.5) and 0.20 (95% CI = 0.12, 0.30). The established efficacy of the IAD is supported by this study. Clinical exams may remain as the final adjunct due to the risks of inaccurate IAD signals. Further studies are warranted to optimize its use for future practice guidelines.",

keywords = "flap monitoring, free flap, implantable doppler, microvascular surgery, systematic review",

author = "Wu, {Kevin G.} and Chong, {Christian T.} and Hunter Hanlon and Langenfeld, {Tyler L.} and Johnson, {R. Michael} and Crawford, {Timothy N.} and Wax, {Mark K.} and Kadakia, {Sameep P.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Head & Neck published by Wiley Periodicals LLC.",

year = "2023",

month = oct,

doi = "10.1002/hed.27500",

language = "English (US)",

volume = "45",

pages = "2710--2717",

journal = "Head and Neck",

issn = "1043-3074",

publisher = "Wiley-Liss Inc.",

number = "10",

}

TY - JOUR

T1 - Implantable arterial doppler efficacy in free flap reconstruction

T2 - A systematic review and meta-analysis

AU - Wu, Kevin G.

AU - Chong, Christian T.

AU - Hanlon, Hunter

AU - Langenfeld, Tyler L.

AU - Johnson, R. Michael

AU - Crawford, Timothy N.

AU - Wax, Mark K.

AU - Kadakia, Sameep P.

PY - 2023/10

Y1 - 2023/10

N2 - The implantable arterial doppler (IAD) is frequently used to postoperatively monitor free flaps with high accuracy, but there are no guidelines for its use. Bedside exam is used adjunctively to determine necessary intervention. This systematic review seeks to discover why the doppler is used adjunctively despite its established record of accuracy. Criteria for inclusion and exclusion were established. In total, 280 articles were found on PubMed and Web of Science, then screened accordingly. Data from 22 articles were analyzed using a bivariate hierarchical random effects model. Twenty-two studies yielded 2996 total patients undergoing 3127 free flap procedures. The meta-analysis found a high sensitivity of 0.809 (95% CI = 0.709, 0.880) and specificity of 0.966 (95% CI = 0.947, 0.979). False-positive rate was found to be 0.034 (95% CI = 0.021, 0.053). Positive and negative predictive values were 0.711 (95% CI = 0.581, 0.817) and 0.979 (95% CI = 0.966, 0.988). Positive and negative likelihood ratios were 24.7 (95% CI = 14.5, 39.5) and 0.20 (95% CI = 0.12, 0.30). The established efficacy of the IAD is supported by this study. Clinical exams may remain as the final adjunct due to the risks of inaccurate IAD signals. Further studies are warranted to optimize its use for future practice guidelines.

AB - The implantable arterial doppler (IAD) is frequently used to postoperatively monitor free flaps with high accuracy, but there are no guidelines for its use. Bedside exam is used adjunctively to determine necessary intervention. This systematic review seeks to discover why the doppler is used adjunctively despite its established record of accuracy. Criteria for inclusion and exclusion were established. In total, 280 articles were found on PubMed and Web of Science, then screened accordingly. Data from 22 articles were analyzed using a bivariate hierarchical random effects model. Twenty-two studies yielded 2996 total patients undergoing 3127 free flap procedures. The meta-analysis found a high sensitivity of 0.809 (95% CI = 0.709, 0.880) and specificity of 0.966 (95% CI = 0.947, 0.979). False-positive rate was found to be 0.034 (95% CI = 0.021, 0.053). Positive and negative predictive values were 0.711 (95% CI = 0.581, 0.817) and 0.979 (95% CI = 0.966, 0.988). Positive and negative likelihood ratios were 24.7 (95% CI = 14.5, 39.5) and 0.20 (95% CI = 0.12, 0.30). The established efficacy of the IAD is supported by this study. Clinical exams may remain as the final adjunct due to the risks of inaccurate IAD signals. Further studies are warranted to optimize its use for future practice guidelines.

KW - flap monitoring

KW - free flap

KW - implantable doppler

KW - microvascular surgery

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=85168855733&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85168855733&partnerID=8YFLogxK

U2 - 10.1002/hed.27500

DO - 10.1002/hed.27500

M3 - Review article

C2 - 37642205

AN - SCOPUS:85168855733

SN - 1043-3074

VL - 45

SP - 2710

EP - 2717

JO - Head and Neck

JF - Head and Neck

IS - 10

ER -

Implantable arterial doppler efficacy in free flap reconstruction: A systematic review and meta-analysis

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this