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Free‐flap telemonitoring to the surgeon's handheld device: Proof of concept

Techniques for free-flap monitoring traditionally rely on clinical examination and experience. A survey of 60 British microsurgical head and neck units suggested that clinical monitoring is the only technique that is universally used. However, 91% used additional tests, including handheld Doppler (55%), temperature probes (50%), laser Doppler flowmetry (5–10%), and near infrared spectroscopy (>5%). Besides the benefit of providing a means to monitor “buried” flaps, such technologies provide quantitative indicators of flap viability in the early postoperative period. However, like clinical monitoring, such measurements may still require experience to interpret fully. Postoperative monitoring needs to be continuous, including when the senior/experienced consultant surgeon is out of the hospital. Consequently, it is often the case that for the first few nights postoperatively, the only on-site surgeon is a junior clinician whose interpretation of the flap status is reliant on a limited amount of experience. In-hospital and community-based cardiac telemetry has proved successful in early recognition of lifethreatening cardiac events and improves survival. Reflecting on this, we sought to create and test a prototype free-flap telemonitoring system for the surgeon using similar technology. We set out to utilize a hospital wireless network (WiFi) and remote desktop software to transmit quantitative data from an electronic flap-monitoring device (the O2C device, LEA Medizintechnik, Germany) to a handheld computer device (personal tablet or smartphone) at the surgeon’s residence. The O2C device has been shown to be a reliable and objective noninvasive technique for free-flap monitoring. It uses laser Doppler and spectrophotometry to