Free Flap Anastomosis Leak after Implantable Doppler Removal

A 74-year-old woman was referred to our center for osteoradionecrosis of the right mandible occurring after dental extraction despite preventive hyperbaric therapy. The patient had been treated by concurrent chemoradiation for a squamous cell carcinoma of the base of tongue >10 years ago. Given the severity of the osteoradionecrosis, a right segmental mandibulectomy with reconstruction via a “tip of the scapula” osseous free flap was planned. During surgery, an implantable Cook-Swartz Doppler probe (Cook Medical, Bloomington, Indiana) was installed 3 cm above the anastomosis on the subscapular artery for postoperative monitoring of the flap. A prophylactic tracheostomy was installed and then weaned postoperatively