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American Association of Plastic Surgeons
33. Doppler Signal Interpretation in Free Tissue Transfer: A Resident Education Tool
Brian P. Thornton, MDPhD, Chris Marek, MD, Dan Stewart, MD, Henry Vasconez, MD.
Univeristy of Kentucky, Lexington, KY, USA.


PURPOSE
Salvaging a failing free flap depends on the early detection of compromised blood flow and immediate surgical intervention. Hand-held Doppler ultrasonography, combined with clinical observation are proven, inexpensive and reliable techniques for post-operative monitoring. However, resident and nursing personnel may have little or no formal training in the use of the Doppler ultrasound for monitoring microvascular free tissue transfer.
METHODS
We have developed a computer based continuing education unit for all nurses involved in postoperative care of free flaps at our institution. The module contains a brief history and understanding of Doppler ultrasonography; an interactive portion that differentiates between arterial and venous signals; and reinforces clinical observations with reference to flap edema, color and temperature. A pre- and post-test was administered to nurses taking part in the continuing education unit and data collected on multiple parameters.
RESULTS
54 nurses who routinely monitor postoperative free flaps have been trained on the Doppler education module. The average nursing age was 28.2 years of age and 94% of nurses were female. The average number of years in nursing was 6.2 and the number of years of monitoring free flaps was 2.7. The average number of flaps taken care of in the career of the nurses was estimated to be 10.3, with 1.7 microvascular free flaps seen in the last month. 90% of respondents who routinely take care of free flaps could not accurately answer in a pre-test questionnaire what the most important clinical observation was in monitoring free flaps. 100% of the nursing staff using the Doppler education module found it extremely education and recommended that any nurse or resident involved in post-operative monitoring of free flaps train with the module.
CONCLUSIONS
Multiple factors contribute to post-operative vascular compromise of free flaps. However, the first step in detection of the failing free flap requires educated and diligent nursing care. We determined that nurses who routinely perform free flap monitoring at our institution have at best a poor understanding of what microvascular tissue transfer means, are very experienced in years of nursing and how to monitor the anastomosis. As work-hour restrictions further limit the amount of hospital time residents can spend in-house, relying on well-trained nursing staff for free flap monitoring becomes even more critical. We have developed the first known computer based simulation device to aide in the education of resident and nursing personnel involved in free flap monitoring. This internet module will be made available for free download.


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