Purpose: We evaluated the outcomes for widely used systems in terms of accuracy, salvage rates, and added cost compared to conventional monitoring. Methods: We performed a narrative review of the literature (high-impact report). Results: The overall free flap success for head and neck reconstruction is at least 95% using any type of monitoring. Salvage rates in decreasing frequency of monitoring techniques are 85% with near-infrared spectroscopy (NIRS), 81% with implantable Doppler, and 61.5% with conventional monitoring. False-positive rates in increasing frequency are 0% for NIRS, 0.4% for conventional monitoring, and <10% for implantable Doppler. Current data show implantable Doppler to be potentially cost-effective for institutions with a failure rate of at least 6%. Buried flaps may be monitored with conventional monitoring using an exteriorized paddle, or using implantable Doppler. Conclusions: The cost-effectiveness of advanced flap monitoring systems beyond conventional monitoring is related to the success rate of each institution. Cost-effectiveness studies are necessary to determine at what point NIRS becomes advantageous.

Lin CM, Huang CC, Hsu H, Chiu CH, Chien SH: Advancements in free flap monitoring in the last decade: a critical review. Plast Reconstr Surg 2010;126:679; author reply 679-680.
Chae MP, Rozen WM, Whitaker IS, Chubb D, Grinsell D, Ashton MW, Hunter-Smith DJ, Lineaweaver WC: Current evidence for postoperative monitoring of microvascular free flaps: a systematic review. Ann Plast Surg 2015;74:621-632.
Poder TG, Fortier PH: Implantable Doppler in monitoring free flaps: a cost-effectiveness analysis based on a systematic review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2013;130:79-85.
Urken ML, Weinberg H, Vickery C, Buchbinder D, Biller HF: Free flap design in head and neck reconstruction to achieve an external segment for monitoring. Arch Otolaryngol Head Neck Surg 1989;115:1447-1453.
Chen Y, Shen Z, Shao Z, Yu P, Wu J: Free flap monitoring using near-infrared spectroscopy: a systemic review. Ann Plast Surg 2016;76:590-597.
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