Enabling Remote Monitoring Using Free Apps and Smart Devices for a Free-Flap Adjunct Monitor

Remote monitoring capability does not currently exist for Periflux (Perimed AB, Järfälla, Sweden) laser Doppler and other perfusion monitors. Two simple adaptations using free apps (applications) and smart devices can enable transmission of the perfusion readout to the surgeon's smartphone. A literature review was conducted to identify reports relating to remote free flap monitoring. In addition, 2 wireless methodologies are devised: One method uses a free app that converts a smart device into a camera, stationed next to the perfusion monitor, to stream live video of the laser Doppler readout to the surgeon's smartphone; a second method uses a free app installed on a bedside laptop computer, which is connected to the laser Doppler flowmeter via a data cord. A live feed of the computer's desktop as a teleconference host is transmitted to the surgeon's smart device over the Internet. These 2 methodologies were employed on 9 and 8 free flaps, respectively, as a pilot study. All free flaps were monitored remotely for 4-6 days with near 100% reliability. The Internet connectivity became disrupted only on several occasions, requiring simple Wi-Fi and software reset. Minor mechanical issues were encountered with the video streaming method. Literature review identified very few articles describing remote monitoring of free flaps. The 2 methodologies reported here provided reliable continuous transmission of quantitative data of flap perfusion to smart devices via Internet connection, which can revolutionize the microsurgeon's practice if his/her adjunctive perfusion monitor with display does not yet have Wi-Fi capability.