As experience and widespread use of free tissue transfer has increased for head and neck reconstruction over the past 20 years, success rates have generally stabilized at well over 95% in most experienced surgeons’ hands. Free tissue transfer has clearly been shown to be the standard of care in complex oromandibular reconstruction. However, it represents substantial use of financial and surgeon resources. Failure, although infrequent, is costly from all perspectives. As such, most microvascular surgeons have used various monitoring techniques after surgery, including visual examination and needle prick, Doppler (implantable and transcutaneous), laser Doppler, and surface temperature monitoring. Because of the low failure rate, plethora of monitoring techniques, and diverse surgeon training, it would be difficult to demonstrate a clinically relevant advantage of any one of these techniques over another.
Ducic Y. Intraoperative Free Flap Monitoring Using Indocyanine Green. JAMA Facial Plast Surg. 2015;17(6):427. doi:10.1001/jamafacial.2015.1060