Intraoperative repair of a transected Cook-Swartz implantable doppler: A salvage technique.

Abstract

Free flap monitoring in the post-operative period is essential in modern practice. With a multitude of monitoring modalities, each institution will have varying monitoring protocols. A common mainstay of free flap monitoring is the use of an implantable doppler, such as the Cook-Swartz doppler (Cook Medical, Bloomington, Indiana, U.S.A), which allows for continuous, real time monitoring of flow through a flap. The doppler relies on a wired connection between the vascular cuff placed around the vessel being monitored, and its base unit where visual and audible representations of flow are produced for clinicians to interpret. The lead is composed of two, braided, insulated wires, which are protected by a plastic covering over the proximal 2/3rd (nearest the base unit); the distal 1/3rd (nearest the cuff) is unprotected. Here, we document our experience following accidental transection of the lead, and our innovative technique in repairing the Cook-Swartz doppler. The signal following repair was continuous and dynamic until planned removal at post-operative day 7.