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Page 12 of 17 Cevallos et al. Plast Aesthet Res 2023;10:30 https://dx.doi.org/10.20517/2347-9264.2023.01

system with infrared systems to address lower image resolution challenges posed by illumination changes
and patient movement [136,137] . This study demonstrated earlier detection of vascular congestion compared to
manual observation. Kim et al. utilized a novel negative pressure wound therapy technique using a
transparent film to monitor the entire flap, allowing for the examination of flap color changes, capillary
refilling status, and flap warmth without missing any portions of the flap . This technique has been shown
[30]
[30]
to reduce monitoring time and costs . Videocapillaroscopy technology shows further promise in
evaluating circulatory changes on the skin surfaces of free flaps while deliberately clamping pedicle
[138]
vessels . Bucknor et al. described a novel, non-invasive, optical oxygen-sensing liquid bandage for post-
operative monitoring in autologous breast reconstruction . This technique uses a camera to continuously
[139]
capture the intensity of oxygen phosphorescence and fluorescence. Hummelink et al. used a “free flap
[140]
patch” adherent to a flap to continuously measure temperature and tissue saturation . The development
of novel, patient-friendly wearable wireless monitors is ongoing, promising rapid and real-time insights into
tissue perfusion.

CONCLUSION
Careful post-operative monitoring of free flaps following breast reconstructive surgery is crucial for
determining procedural success. While the clinical examination remains the gold standard for post-
operative flap monitoring, various adjuncts exist to complement and enhance our understanding of flap
perfusion.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Cevallos PC, Najafali D, Johnstone TM
Performed data acquisition, as well as provided administrative, technical, and material support: Borrelli MR,
Manrique OJ, Lee GK, Nazerali RS

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023

REFERENCES
1. Saber AY, Hohman HM, Dreyer MA. Basic flap design. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563252/ [Last
accessed on 19 Jun 2023].