Imaging in the Postoperative Period

Imaging is an indispensable tool for monitoring tissue viability, diagnosing complications, and guiding postoperative revisions following microsurgical reconstruction. In the immediate postoperative period, imaging is especially useful for monitoring time-sensitive complications such as flap thrombosis, deep vein thrombosis (DVT), hematoma, seroma, and soft tissue infections. Ultrasonography in particular is an integral component of postoperative diagnostic and therapeutic care in reconstructive microsurgery. It provides a versatile and cost-effective point-of-care modality for real-time visualization of anatomic integrity and assessment of vascular flow and can also be utilized as an adjunct to postoperative interventions such as pain management. In addition, relatively newer imaging modalities such as infrared thermography and oxygen perfusion imaging have shown promise for augmenting flap monitoring protocols. In this chapter, we discuss various imaging modalities and their uses in the postoperative phase, with a focus on ultrasonography and Doppler imaging. We will introduce our algorithm for flap monitoring and discuss the ways in which imaging has become integrated into routine postoperative management following microsurgical procedures.