The Experts below are selected from a list of 282 Experts worldwide ranked by ideXlab platform
Rafael Acosta - One of the best experts on this subject based on the ideXlab platform.
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Buried free flaps for breast reconstruction: a new technique using the Cook-Swartz implantable Doppler Probe for postoperative monitoring.
Plastic and Reconstructive Surgery, 2020Co-Authors: Warren M Rozen, Iain S Whitaker, Thorir Audolfsson, Marcus J. D. Wagstaff, Rafael AcostaAbstract:Buried Free Flaps for Breast Reconstruction : A New Technique Using the Cook-Swartz Implantable Doppler Probe for Postoperative Monitoring
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sutured attachment of the implantable Doppler Probe cuff for large or complex pedicles in free tissue transfer
Journal of Reconstructive Microsurgery, 2011Co-Authors: Warren M Rozen, Rafael Acosta, Anthony Mcdonald, Gausihi Sivarajah, Richard Rahdon, Damon J ThomasAbstract:: The Cook-Swartz implantable Doppler Probe (Cook Medical(®), Cook Ireland Ltd., Limerick, Ireland) has evolved as a useful option for postoperative free flap monitoring. For placement, the Probe either is left unattached around the venous pedicle or is secured. In our experience with over 300 applications, we typically secure the cuff with two small microclips, or use fibrin glue. These techniques require redundant silicone cuff for apposition; however, we have encountered some vessels that are of sufficiently large diameter as to not provide enough cuff to employ these methods. The first technique comprises the application of two interrupted sutures through the cuff ends to mimic the technique of microclips. The sutures can be tightened to the desired tension and can be used in cases where the cuff ends are not in direct apposition. A second technique is to excise a segment of silicone cuff and either clip or suture the excised segment to the cuff ends, effectively elongating the cuff diameter. All four techniques (nonattachment, microclip fixation, suture fixation, silicone cuff elongation) have been used effectively, and none have resulted in any complications. Of note, the technique of nonattachment was associated with an increased rate of false-positive results, as migration away from the vessel was postulated to have occurred. There are a range of techniques for attachment of the implantable Doppler Probe, and each contributes to the range of options for cuff attachment in difficult cases, with each technique worthwhile in particular settings.
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postoperative monitoring of lower limb free flaps with the cook swartz implantable Doppler Probe a clinical trial
Microsurgery, 2010Co-Authors: Warren M Rozen, Morteza Enajat, Iain S Whitaker, Ulrica Lindkvist, Thorir Audolfsson, Rafael AcostaAbstract:Background: Free flaps to the lower limb have inherently high venous pressures, potentially impairing flap viability, which may lead to limb amputation if flap failure ensues. Adequate monitoring of flap perfusion is thus essential, with timely detection of flap compromise able to potentiate flap salvage. While clinical monitoring has been popularized, recent use of the implantable Doppler Probe has been used with success in other free flap settings. Methods: A comparative study of 40 consecutive patients undergoing microvascular free flap reconstruction of lower limb defects was undertaken, with postoperative monitoring achieved with either clinical monitoring alone or the use of the Cook-Swartz implantable Doppler Probe. Results: The use of the implantable Doppler Probe was associated with salvage of 2/2 compromised flaps compared to salvage of 2/5 compromised flaps in the group undergoing clinical monitoring alone (salvage rate 100% vs. 40%, P = 0.28). While not statistically significant, this was a strong trend toward an improved flap salvage rate with the use of the implantable Doppler Probe. There were no false positives or negatives in either group. One flap loss in the clinically monitored group resulted in limb amputation (the only amputation in the cohort). Conclusion: A trend toward early detection and salvage of flaps with anastomotic insufficiency was seen with the use of the Cook–Swartz implantable Doppler Probe. These findings suggest a possible benefit of this technique as a stand-alone or adjunctive tool in the clinical monitoring of free flaps, with further investigation warranted into the broader application of these devices. © 2009 Wiley-Liss, Inc. Microsurgery 30:354–360, 2010.
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the efficacy of postoperative monitoring a single surgeon comparison of clinical monitoring and the implantable Doppler Probe in 547 consecutive free flaps
Microsurgery, 2010Co-Authors: Warren M Rozen, Iain S Whitaker, Daniel Chubb, Rafael AcostaAbstract:Background: An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone. Methods: A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook-Swartz implantable Doppler Probe. Outcome measures included flap salvage rate and false-positive rate. Results: There was a strong trend toward improved salvage rates with the implantable Doppler Probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta-analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false-positive rates. Conclusion: Flap monitoring with the implantable Doppler Probe can improve flap salvage rates without increasing the rate of false-positive takebacks. © 2009 Wiley-Liss, Inc. Microsurgery, 2010.
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postoperative monitoring of free flaps in autologous breast reconstruction a multicenter comparison of 398 flaps using clinical monitoring microdialysis and the implantable Doppler Probe
Journal of Reconstructive Microsurgery, 2010Co-Authors: Iain S Whitaker, Warren M Rozen, Rafael Acosta, Birgitte Jul Kiil, Daniel Chubb, Hanne Birkesorensen, Damien Grinsell, Mark W AshtonAbstract:Many techniques for flap monitoring following free tissue transfer have been described; however, there is little evidence that any of these techniques allow for greater rates of flap salvage over clinical monitoring alone. We sought to compare three established monitoring techniques across three experienced microsurgical centers in a comparable cohort of patients. A retrospective, matched cohort study of 398 consecutive free flaps in 347 patients undergoing autologous breast reconstruction was undertaken across three institutions during the same 3-year period, with a single form of postoperative monitoring used at each institution: clinical monitoring alone, the Cook-Swartz implantable Doppler Probe, or microdialysis. Both objective and subjective measures of efficacy were assessed. Clinical monitoring alone, the implantable Doppler Probe, and microdialysis showed statistically similar rates of flap salvage. False-negative rates were also statistically similar (only seen in the clinically monitored group). However, there was a statistically significant increase in false-positive alarms causing needless take-backs to theater in the microdialysis and implantable Doppler arms, p < 0.001. This study did not find any technique superior to clinical monitoring alone. New monitoring technologies should be compared objectively with clinical monitoring as the current standard in postoperative flap monitoring.
Warren M Rozen - One of the best experts on this subject based on the ideXlab platform.
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Buried free flaps for breast reconstruction: a new technique using the Cook-Swartz implantable Doppler Probe for postoperative monitoring.
Plastic and Reconstructive Surgery, 2020Co-Authors: Warren M Rozen, Iain S Whitaker, Thorir Audolfsson, Marcus J. D. Wagstaff, Rafael AcostaAbstract:Buried Free Flaps for Breast Reconstruction : A New Technique Using the Cook-Swartz Implantable Doppler Probe for Postoperative Monitoring
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direct comparison of postoperative monitoring of free flaps with microdialysis implantable cook swartz Doppler Probe and clinical monitoring in 20 consecutive patients
Microsurgery, 2015Co-Authors: Markus Winther Frost, Warren M Rozen, Vachara Niumsawatt, Gete Ester Toft Eschen, Tine Engberg Damsgaard, Birgitte Jul KiilAbstract:Background There is an increasing demand for successful free tissue transfer, with postoperative monitoring of flaps a key to early salvage. Monitoring methods have ranged from clinical techniques to invasive options, of which two are particularly applicable to buried flaps (Cook-Swartz Doppler Probe and microdialysis). The evidence for these options has been represented largely in separate cohort studies, with no single study comparing these three techniques. We aim to perform this comparison in a single cohort of patients. Methods A prospective, consecutive cohort study comparing clinical monitoring, microdialysis and the implantable Doppler Probe was undertaken. In 20 patients receiving 22 flaps, 21 flaps were monitored with microdialysis, 18 flaps with clinical observation, and 21 flaps with the Cook-Swartz Implantable Doppler Probe. Exclusion was based on applicability and availability intra-operatively. Efficacy was assessed through sensitivity, specificity, positive, and negative predictive values. Results Nineteen of 22 flaps had no suspected anastomotic problems; 3 of 22 flaps were explored for anastomotic problems, with two salvaged and one lost. The implantable Doppler and microdialysis were found to detect flap statistically earlier than clinical assessment, with microdialysis better at detecting flap compromise: 100% specificity (confidence interval 31–100%) when compared to the implantable Probe and clinical assessment (67%: 13–98% and 33%: 2–87%, respectively). Conclusions Each of the Cook-Swartz Doppler Probe, microdialysis and clinical assessment was found suitable for monitoring in free tissue transfer. The implantable Doppler and microdialysis offer the potential for earlier detection of flap compromise. © 2014 Wiley Periodicals, Inc. Microsurgery 35:262–271, 2015.
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sutured attachment of the implantable Doppler Probe cuff for large or complex pedicles in free tissue transfer
Journal of Reconstructive Microsurgery, 2011Co-Authors: Warren M Rozen, Rafael Acosta, Anthony Mcdonald, Gausihi Sivarajah, Richard Rahdon, Damon J ThomasAbstract:: The Cook-Swartz implantable Doppler Probe (Cook Medical(®), Cook Ireland Ltd., Limerick, Ireland) has evolved as a useful option for postoperative free flap monitoring. For placement, the Probe either is left unattached around the venous pedicle or is secured. In our experience with over 300 applications, we typically secure the cuff with two small microclips, or use fibrin glue. These techniques require redundant silicone cuff for apposition; however, we have encountered some vessels that are of sufficiently large diameter as to not provide enough cuff to employ these methods. The first technique comprises the application of two interrupted sutures through the cuff ends to mimic the technique of microclips. The sutures can be tightened to the desired tension and can be used in cases where the cuff ends are not in direct apposition. A second technique is to excise a segment of silicone cuff and either clip or suture the excised segment to the cuff ends, effectively elongating the cuff diameter. All four techniques (nonattachment, microclip fixation, suture fixation, silicone cuff elongation) have been used effectively, and none have resulted in any complications. Of note, the technique of nonattachment was associated with an increased rate of false-positive results, as migration away from the vessel was postulated to have occurred. There are a range of techniques for attachment of the implantable Doppler Probe, and each contributes to the range of options for cuff attachment in difficult cases, with each technique worthwhile in particular settings.
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postoperative monitoring of lower limb free flaps with the cook swartz implantable Doppler Probe a clinical trial
Microsurgery, 2010Co-Authors: Warren M Rozen, Morteza Enajat, Iain S Whitaker, Ulrica Lindkvist, Thorir Audolfsson, Rafael AcostaAbstract:Background: Free flaps to the lower limb have inherently high venous pressures, potentially impairing flap viability, which may lead to limb amputation if flap failure ensues. Adequate monitoring of flap perfusion is thus essential, with timely detection of flap compromise able to potentiate flap salvage. While clinical monitoring has been popularized, recent use of the implantable Doppler Probe has been used with success in other free flap settings. Methods: A comparative study of 40 consecutive patients undergoing microvascular free flap reconstruction of lower limb defects was undertaken, with postoperative monitoring achieved with either clinical monitoring alone or the use of the Cook-Swartz implantable Doppler Probe. Results: The use of the implantable Doppler Probe was associated with salvage of 2/2 compromised flaps compared to salvage of 2/5 compromised flaps in the group undergoing clinical monitoring alone (salvage rate 100% vs. 40%, P = 0.28). While not statistically significant, this was a strong trend toward an improved flap salvage rate with the use of the implantable Doppler Probe. There were no false positives or negatives in either group. One flap loss in the clinically monitored group resulted in limb amputation (the only amputation in the cohort). Conclusion: A trend toward early detection and salvage of flaps with anastomotic insufficiency was seen with the use of the Cook–Swartz implantable Doppler Probe. These findings suggest a possible benefit of this technique as a stand-alone or adjunctive tool in the clinical monitoring of free flaps, with further investigation warranted into the broader application of these devices. © 2009 Wiley-Liss, Inc. Microsurgery 30:354–360, 2010.
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the efficacy of postoperative monitoring a single surgeon comparison of clinical monitoring and the implantable Doppler Probe in 547 consecutive free flaps
Microsurgery, 2010Co-Authors: Warren M Rozen, Iain S Whitaker, Daniel Chubb, Rafael AcostaAbstract:Background: An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone. Methods: A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial inferior epigastric artery (SIEA) flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook-Swartz implantable Doppler Probe. Outcome measures included flap salvage rate and false-positive rate. Results: There was a strong trend toward improved salvage rates with the implantable Doppler Probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta-analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false-positive rates. Conclusion: Flap monitoring with the implantable Doppler Probe can improve flap salvage rates without increasing the rate of false-positive takebacks. © 2009 Wiley-Liss, Inc. Microsurgery, 2010.
Toshimi Arai - One of the best experts on this subject based on the ideXlab platform.
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Central venous catheterization in infants and children – small caliber audio‐Doppler Probe versus ultrasound scanner
Pediatric Anesthesia, 2005Co-Authors: Toshimi Arai, Yamashita MasaoAbstract:Summary Background : Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio-Doppler Probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children. Methods : Fifty-two infants and 29 children scheduled for open-heart surgery were enrolled. Cannulation was guided using a small caliber audio-Doppler Probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups. Results : In children (>12 months), both methods were equally efficient. But in infants (
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central venous catheterization in infants and children small caliber audio Doppler Probe versus ultrasound scanner
Pediatric Anesthesia, 2005Co-Authors: Toshimi Arai, Yamashita MasaoAbstract:Summary Background : Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio-Doppler Probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children. Methods : Fifty-two infants and 29 children scheduled for open-heart surgery were enrolled. Cannulation was guided using a small caliber audio-Doppler Probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups. Results : In children (>12 months), both methods were equally efficient. But in infants (<12 months), success rate at the first attempt using audio-Doppler was worse than the rate using an ultrasound scanner and there were more complications when audio-Doppler was used. Conclusions : We conclude that application of both the audio-Doppler and the ultrasound scanner is useful in children over 1 year of age for access to the internal jugular vein. However, in infants and neonates, the ultrasound scanner would be more useful than the audio-Doppler.
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Audio-Doppler guidance using a small-caliber Doppler Probe for internal jugular venous puncture for central venous catheterization in infants and children.
Pediatric Anesthesia, 2004Co-Authors: Toshimi Arai, Masao YamashitaAbstract:Summary Background : We evaluated an audio-Doppler with a small-caliber Probe as a guide for central venous cannulation (CVC) via the internal jugular vein (IJV) in infants and children. Methods : The right IJV was located with a small-caliber (2.0 mm in diameter) audio-Doppler Probe using 10 MHz ultrasound. The Probe was placed on the neck about the level of sixth cervical vertebra and was moved until the crisp pulsatile sound of the carotid artery was identified. Then the Probe was moved laterally to identify the low-pitched venous hum of the right IJV. After marking the puncture site on the skin, a sterile cannulation procedure was performed. Ultimate success rate, cannulation time
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audio Doppler guidance using a small caliber Doppler Probe for internal jugular venous puncture for central venous catheterization in infants and children
Pediatric Anesthesia, 2004Co-Authors: Toshimi Arai, Masao YamashitaAbstract:Summary Background : We evaluated an audio-Doppler with a small-caliber Probe as a guide for central venous cannulation (CVC) via the internal jugular vein (IJV) in infants and children. Methods : The right IJV was located with a small-caliber (2.0 mm in diameter) audio-Doppler Probe using 10 MHz ultrasound. The Probe was placed on the neck about the level of sixth cervical vertebra and was moved until the crisp pulsatile sound of the carotid artery was identified. Then the Probe was moved laterally to identify the low-pitched venous hum of the right IJV. After marking the puncture site on the skin, a sterile cannulation procedure was performed. Ultimate success rate, cannulation time <10 min, successful cannulation within three punctures, and complications were recorded. Results : Ultimate success rate was 65.6% (42/64) in infants (<12 m), and 94.7% (72/76) in children (12 m or older). Cannulation time <10 min was 48.4% in infants, and 85.5% in children. Successful cannulation within three punctures was 45.3% in infants and 82.8% in children. Three carotid arterial punctures occurred. Conclusions : We were not able to demonstrate absolute superiority of the results utilizing this device over the reported results of traditional landmark techniques for CVC via the right IJV. However, this device may contribute to reducing complications and be of value in teaching residents where to insert a needle for an internal jugular puncture.
Richard C.k. Wong - One of the best experts on this subject based on the ideXlab platform.
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use of Doppler Probe in nonvariceal upper gastrointestinal bleeding is less costly and more effective than standard of care
Clinical Gastroenterology and Hepatology, 2019Co-Authors: Alan N Barkun, Viviane Adam, Richard C.k. WongAbstract:Background & Aims Upper gastrointestinal bleeding is a common emergency and rebleeding is associated with an increased risk of death. Proper assessment of high-risk lesions and appropriate endoscopic hemostasis are required for the best outcomes. The endoscopic Doppler Probe examination (DPE) allows for a more complete assessment of the stigmata of hemorrhage, providing better evaluation of the need for endoscopic hemostasis and determination of its completeness. We aimed to evaluate whether use of the DPE provides an additional advantage in cost and effectiveness compared with traditional endoscopic visual assessment (TEA) of high-risk stigmata in patients with nonvariceal upper gastrointestinal bleeding. Methods We drew a decision tree representing the choice between DPE and TEA approaches for patients undergoing an index endoscopy for active nonvariceal upper gastrointestinal bleeding. Clinical probabilities were retrieved from randomized controlled trial data. Costs were expressed in 2017 US dollars. A third-party payer perspective was adopted. We performed deterministic and probabilistic sensitivity analyses. The adopted time horizon was 30 days after the index endoscopy. Results We found that DPE is a dominant strategy over the TEA, in that DPE is more efficacious (92.6% of patients avoiding rebleeding vs 78.6% for TEA) and less expensive ($8502 vs $9104 for TEA). The economic dominance of DPE over TEA was robust to sensitivity analyses across all assumptions of the model when varied among ranges spanning 30% of their respective baseline values. Conclusions In a cost-effectiveness analysis, we found DPE to be an economically dominant strategy to TEA (the traditional approach) in the management of high-risk lesions in patients with nonvariceal upper gastrointestinal bleeding. DPE was less costly and more effective.
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Endoscopic Doppler Probe in the Diagnosis and Management of Upper Gastrointestinal Hemorrhage.
ACG Case Reports Journal, 2018Co-Authors: Sagarika Satyavada, Perica Davitkov, Gregory S. Cooper, Richard C.k. Wong, Amitabh ChakAbstract:: Through-the-scope (TTS) endoscopic Doppler ultrasound Probe technology is a tool that has garnered interest for the evaluation of variceal and non-variceal bleeding. In previous studies, this technology has been proposed as a more objective method of identifying the bleeding subsurface blood vessel in peptic ulcer hemorrhage. We describe 3 cases where the use of an endoscopic Doppler Probe guided the diagnosis and management of upper gastrointestinal (GI) hemorrhage due to causes other than peptic ulcer disease. The first case describes a patient with a duodenal Dieulafoy lesion, while the other 2 cases outline patients with a gastroesophageal varix as the etiology of the bleed.
Yamashita Masao - One of the best experts on this subject based on the ideXlab platform.
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Central venous catheterization in infants and children – small caliber audio‐Doppler Probe versus ultrasound scanner
Pediatric Anesthesia, 2005Co-Authors: Toshimi Arai, Yamashita MasaoAbstract:Summary Background : Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio-Doppler Probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children. Methods : Fifty-two infants and 29 children scheduled for open-heart surgery were enrolled. Cannulation was guided using a small caliber audio-Doppler Probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups. Results : In children (>12 months), both methods were equally efficient. But in infants (
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central venous catheterization in infants and children small caliber audio Doppler Probe versus ultrasound scanner
Pediatric Anesthesia, 2005Co-Authors: Toshimi Arai, Yamashita MasaoAbstract:Summary Background : Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio-Doppler Probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children. Methods : Fifty-two infants and 29 children scheduled for open-heart surgery were enrolled. Cannulation was guided using a small caliber audio-Doppler Probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups. Results : In children (>12 months), both methods were equally efficient. But in infants (<12 months), success rate at the first attempt using audio-Doppler was worse than the rate using an ultrasound scanner and there were more complications when audio-Doppler was used. Conclusions : We conclude that application of both the audio-Doppler and the ultrasound scanner is useful in children over 1 year of age for access to the internal jugular vein. However, in infants and neonates, the ultrasound scanner would be more useful than the audio-Doppler.