The Use of the Implantable Doppler Probe as a Blood Flow Monitoring Device in Clinical Settings: A Narrative Review of the Evidence

Present and Future of Autologous Breast Reconstruction: Advancing Techniques to Minimize Morbidity and Complications, Enhancing Quality of Life and Patient Satisfaction

Background: Autologous breast reconstruction has undergone a remarkable evolution, driven by the pursuit of addressing past concerns primarily related to donor site morbidity and complication risks. Improved techniques now prioritize minimizing invasiveness, complications, and recovery time while achieving aesthetically pleasing and durable results. Methods: Recent advancements in autologous breast reconstruction have been examined, focusing on enhancements in surgical techniques, imaging technologies, minimally invasive approaches, and postoperative care. Results: To reduce donor site morbidity, attention has recently shifted back to abdominal flaps vascularized by subcutaneous vessels. Specifically, the superficial circumflex iliac artery perforator (SCIP) flap has emerged as a promising option. Additionally, robotic-assisted flap harvest serves as another method to reduce the invasiveness. At the recipient site, rib-sparing internal mammary vessel isolation and perforator-to-perforator anastomosis have been suggested to lessen trauma and maintain thoracic integrity. The use of thorough preoperative imaging and intraoperative assessment of real-time perfusion with indocyanine green angiography (ICG) has enhanced the success of the procedure. Beyond aesthetic restoration, contemporary breast reconstructive surgeons are increasingly aware of both short-term and long-term complications, particularly lymphatic sequelae. The LYMPHA technique (lymphatic microsurgical preventive healing approach) promotes immediate restoration of the lymphatic system and has shown the potential to reduce the risk of breast cancer-related lymphedema (BCRL). Furthermore, the integration of enhanced recovery after surgery (ERAS) protocols has transformed perioperative care by optimizing pain management, minimizing hospitalization duration, and allowing a quicker return to daily activities. Conclusions: Recent advancements in autologous breast reconstruction have significantly improved patient outcomes. With innovations in flap design, technology, lymphatic preservation, and recovery protocols, it has been possible to usher in a new era of less invasive procedures and fewer complications while achieving high aesthetic results and allowing patients to return to their daily lives as quickly as possible.

Effectiveness of Implantable Doppler Probe Versus Standard Clinical Care in Preventing Thrombosis-Related Graft Loss in Kidney Transplantation: A Systematic Review and Meta-Analysis

OBJECTIVES

The implantable Doppler probe can monitor the patency of vascular anastomosis, thereby facilitating early detection of vascular thrombosis critical to reducing graft loss. In this study, we examined the effectiveness of this technology compared with standard clinical care in reducing thrombosis-related graft loss and the requirement for color duplex ultrasonography in the first 24 hours postoperatively by a medical literature search of the application of this technology in kidney transplantation.

MATERIALS AND METHODS

We conducted a systematic search (January 15, 2024) of a wide range of experimental and observational studies that comprised kidney transplant recipients monitored with blood flow sensing technology (intervention group) and standard clinical care (control group). Primary outcomes were differences between groups of thrombosis-related graft loss and surveillance requirement of color duplex ultrasonography scans in the first 24 hours postoperatively. Two independent researchers conducted critical appraisal and data extraction of the selected papers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. We used a random effects model for the meta-analysis. Dichotomous outcomes were expressed as relative risk or odds ratio.

RESULTS

The search identified 43 articles. After exclusion criteria, 7 studies (1 experimental, 6 observational) were included, with a total participant sample of 874 adult kidney transplant recipients with and without blood flow sensing technology. The certainty of evidence level was rated as moderate. Blood flow sensing technology resulted in a 66% reduction in the risk of thrombosis-related graft loss and a 61% lower probability of requiring color duplex ultrasonography in the first 24 hours postoperatively compared with standard clinical care.

CONCLUSIONS

Blood flow sensing technology can be used as a helpful adjunct in the postoperative monitoring of kidney transplant recipients. However, given the technical limitations, signals should be interpreted alongside the traditional clinical assessment techniques.

Experiences of Participation in a Study Investigating Feasibility of the Implantable Doppler Probe in Kidney Transplantation: An Embedded Qualitative Study

OBJECTIVES

Kidney transplant survival can be improved with better graft surveillance postoperatively. In the quest to explore new technologies, we explored the feasibility of an implantable Doppler probe as a blood flow monitoring device in kidney transplant patients. This qualitative study was embeddedin a feasibility trial and aimed to test the device's clinical acceptability and obtain suggestions for the development of the intervention. Objectives included exploring the experiences of feasibility study participants and identifying barriers to the implementation of implantable Doppler probes in clinical practice.

MATERIALS AND METHODS

We conducted semi-structured interviews containing open-ended questions with 12 feasibility study participants recruited by purposive sampling. All interviews were audio-recorded with verbatim transcription. Thematic data analysis was performed at the latent level by using an inductive approach with a previously published 6-phase guide.

RESULTS

Three key themes emerged: (1) perceived value of the intervention in clinical practice, (2) challenges and barriers to implementation of the intervention, and (3) suggestions forthe development of the intervention. Due to functional limitations and lack of research, medical professional participants revealed clinical equipoise regarding the utility of implantable Doppler probes. However,the device was well received by patient participants. Challenges included device training needs for medical professionals and educational sessions for patients. Innovative ideas for development included the insertion of a display screen, adopting disposable units to reduce overall cost, online access allowing remote monitoring, decreasing external monitoring unit size, and integrating a wireless connection with the probe to reduce signal errors and increase patient safety.

CONCLUSIONS

The clinical need for blood flow sensing technology in kidney transplants has been widely acknowledged. Implantable Doppler probes may be a beneficial adjunct in the early postoperative surveillance of kidney transplant patients. However, the device's technical limitations are the main challenges to its acceptance in clinical practice.

A Study Protocol Exploring the Role of an Implantable Doppler Probe in Kidney Transplantation: A Feasibility Randomized Controlled Trial with an Embedded Qualitative Study

OBJECTIVES

Vascular complications in kidney transplant surgery constitute one-third of early graft loss, which can be prevented by timely diagnosis of vascular compromise. A blood flow monitoring device may have a beneficial role in the early identification of graft hypoperfusion critical to reducing graft loss. This research protocol aims to evaluate the potential of an implantable Doppler probe as a blood flow monitoring device in kidney transplant recipients.

MATERIALS AND METHODS

The potential study will be a mixed methodology, 2-arm feasibility randomized controlled trial with an embedded qualitative study. For the trial, we will compare demographic characteristics and outcome measures of kidney transplant patients receiving implantable Doppler probe monitoring (intervention group, n = 30) with those having standard clinical care (control group). For the qualitative study, we will conduct semi-structured interviews with stakeholders (n = 12) recruited by purposive sampling to explore experiences of participants. All interviews will be audio recorded with verbatim transcription.

RESULTS

Our results will use the summarized quantitative data and descriptive statistics to determine differences between the groups. We will use CONSORT guidelines to determine the suitability of the research processes, availability of research resources, and potential challenges faced during the feasibility randomized controlled trial. We will use thematic analysis and NVivo software to analyze the acceptability of the intervention in clinical practice. We will compile the results according to the consolidated criteria for reporting qualitative research checklist.

CONCLUSIONS

The goal of this protocol is to determine the feasibility of an implantable Doppler probe monitoring device in kidney transplant recipients. The feasibility study will collect preliminary information, fill gaps in evidence, and test research processes for the pragmatic future randomized controlled trial. The template of this study is transferable to other transplant centers across the United Kingdom.