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Abstract：
To assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps.
Retrospective single-institution study, April 2015 to March 2017.
Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback. Sensitivity, specificity, and false positive rate (FPR) were recorded for each device. Logistic regression was conducted to identify user trends over time.
Eleven of 120 patients (9.2%) required takeback, 10 from venous thrombosis and one from arterial thrombosis. Permanent signal loss (PSL) occurred in the flow coupler in all takebacks; PSL occurred in the arterial Doppler only in the case of arterial thrombosis. Salvage rate was 9/11 (81.8%). For the flow coupler, sensitivity was 100%, specificity 86.4%, and FPR 13.6%. For the arterial probe, sensitivity was 9.1%, specificity 97.1%, and FPR 2.9%. A 4.1% decrease in false positives with each additional flow coupler use was observed.
Monitoring the vein via flow coupler has high sensitivity in identifying vascular compromise compared to the arterial probe, especially for venous thrombosis. There is moderate FPR; this decreases with increased usage and, when supplemented with physical examination, does not result in unnecessary takebacks. The flow coupler can be a valuable tool in postoperative monitoring of head and neck free flaps.
4. Laryngoscope, 128:812-817, 2018.
Retrospective single-institution study, April 2015 to March 2017.
Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback. Sensitivity, specificity, and false positive rate (FPR) were recorded for each device. Logistic regression was conducted to identify user trends over time.
Eleven of 120 patients (9.2%) required takeback, 10 from venous thrombosis and one from arterial thrombosis. Permanent signal loss (PSL) occurred in the flow coupler in all takebacks; PSL occurred in the arterial Doppler only in the case of arterial thrombosis. Salvage rate was 9/11 (81.8%). For the flow coupler, sensitivity was 100%, specificity 86.4%, and FPR 13.6%. For the arterial probe, sensitivity was 9.1%, specificity 97.1%, and FPR 2.9%. A 4.1% decrease in false positives with each additional flow coupler use was observed.
Monitoring the vein via flow coupler has high sensitivity in identifying vascular compromise compared to the arterial probe, especially for venous thrombosis. There is moderate FPR; this decreases with increased usage and, when supplemented with physical examination, does not result in unnecessary takebacks. The flow coupler can be a valuable tool in postoperative monitoring of head and neck free flaps.
4. Laryngoscope, 128:812-817, 2018.
摘要：
评估流量耦合器相对于植入式动脉多普勒探头在头颈部游离皮瓣术后监测中的准确性和可靠性。
回顾性单机构研究，2015年4月至2017年3月。
在120例连续的头颈部游离皮瓣中，同时采用了静脉血流耦合器和动脉多普勒。当多普勒信号丢失时，通过体格检查评估皮瓣，以确定信号丢失是否是真正的阳性，需要手术室回收。灵敏度,特异性，记录每个设备的假阳性率（FPR）。进行逻辑回归以识别用户随时间的趋势。
120名患者中有11名（9.2％）需要撤回，10来自静脉血栓形成，1来自动脉血栓形成。永久性信号损失（PSL）发生在所有回送中的流量耦合器中；PSL仅在动脉血栓形成的情况下发生在动脉多普勒中。抢救率为9/11(81.8%)。对于流量耦合器，灵敏度为100%,特异性86.4%，和FPR13.6%。对于动脉探针，灵敏度为9.1%，特异性97.1%，和FPR2.9%。观察到每次使用额外的流量耦合器时，假阳性减少了4.1％。
与动脉探头相比，通过流量耦合器监测静脉在识别血管受损方面具有很高的灵敏度，尤其是静脉血栓形成.有适度的FPR；这随着使用量的增加而减少，当补充体检时，不会导致不必要的回收。流量耦合器可以是术后监测头颈部自由皮瓣的有价值的工具。
4.喉镜,128:812-817,2018.
回顾性单机构研究，2015年4月至2017年3月。
在120例连续的头颈部游离皮瓣中，同时采用了静脉血流耦合器和动脉多普勒。当多普勒信号丢失时，通过体格检查评估皮瓣，以确定信号丢失是否是真正的阳性，需要手术室回收。灵敏度,特异性，记录每个设备的假阳性率（FPR）。进行逻辑回归以识别用户随时间的趋势。
120名患者中有11名（9.2％）需要撤回，10来自静脉血栓形成，1来自动脉血栓形成。永久性信号损失（PSL）发生在所有回送中的流量耦合器中；PSL仅在动脉血栓形成的情况下发生在动脉多普勒中。抢救率为9/11(81.8%)。对于流量耦合器，灵敏度为100%,特异性86.4%，和FPR13.6%。对于动脉探针，灵敏度为9.1%，特异性97.1%，和FPR2.9%。观察到每次使用额外的流量耦合器时，假阳性减少了4.1％。
与动脉探头相比，通过流量耦合器监测静脉在识别血管受损方面具有很高的灵敏度，尤其是静脉血栓形成.有适度的FPR；这随着使用量的增加而减少，当补充体检时，不会导致不必要的回收。流量耦合器可以是术后监测头颈部自由皮瓣的有价值的工具。
4.喉镜,128:812-817,2018.
