Arterialized venous perfusion of composite tissue

Nichter, Larry S.; Haines, Peter C.

doi:10.1016/0002-9610(85)90117-5

Cited by 41 publications

(11 citation statements)

References 36 publications

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“…The circulation through the venous network can supply small flaps. Flaps of larger size require a greater gradient between the proximal and distal ends of the flap (4,5,8,13,16). An example is a venous flap with arterialised blood perfusion.…”

Section: Discussionmentioning

confidence: 99%

Microcirculation of a Venous Flap: An Experimental Study With Microspheres in Rabbits

Tang

Simchon²,

Chen³

2000

Scandinavian Journal of Plastic and Reconstructive Surgery and

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In recent years, it has been found that maintenance of venous circulation alone may support a small flap with no direct arterial inflow. The clinical application of a venous flap has potential in the field of microsurgery. The purpose of this study was to evaluate the haemodynamics within a pedicled venous flap in rabbits, compared with those of a composite graft. Pedicled venous flaps and composite grafts were raised from the abdominal walls of 30 adult New Zealand rabbits. Flap survival was measured and recorded and blood flow studies with microspheres were done for seven days. The viability of the pedicled venous flaps was much better than that of the composite grafts. At two weeks 24 of the venous flaps (80%) showed more than 75% surviving, but 29 (97%) of the composite grafts had less than 25% surviving. The results suggest that the blood flow through a patent vein maintained in a venous skin flap can provide enough nutrients for the flap to survive during the initial three days until neovascularisation. The venous flap receives more blood flow than a composite graft. We conclude that a venous flap depends on blood supply from the axial vein in addition to neovascularisation to maintain its survival.

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Section: Discussionmentioning

confidence: 99%

Microcirculation of a Venous Flap: An Experimental Study With Microspheres in Rabbits

Tang

Simchon²,

Chen³

2000

Scandinavian Journal of Plastic and Reconstructive Surgery and

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“…Nichter et al 5 hypothesized that arterialized venous perfusion was a viable means of nourishing complex composite tissue without using the arterial system. Germann et al 1 demonstrated that the true blood flow reversal occurred in an experiment.…”

Section: Discussionmentioning

confidence: 99%

Afferent Arteriovenous Fistula in Thumb Revascularization

1997

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A case of traumatic devascularized unviable thumb was revascularized using an afferent arteriovenous fistula. It proves again that this technique provides an alternative means of reimplantation/revascularization when no suitable artery for anastomosis is available in the devascularized/amputated part.Until now, only a few reported cases of successful reimplantation of the digits were done using afferent arteriovenous fistula.For the last decade, research studies have provided important physiological effects of flow reversal in the venous system. Most of the research works were encouraging. Recently a number of successful reimplantation/revascularization of digits and other composite structures were reported. Case ReportThe patient was a 28-year-old male admitted to King Khalid University Hospital with a devascularized right thumb. He had suffered a severe crush injury with a rotatory machine at the base of the right thumb over the volar aspect. The soft tissues were crushed for three-fourths of the whole of the base circumference. Both the digital vessels were completely severed and crushed. The ulnar digital nerve was cut and lacerated. The radial digital nerve was crushed but was intact.The proximal phalanx was shattered in multiple pieces (Figure 1). The flexor and extensor pollicis longus were intact. A small piece of the dorsal skin was lacerated but apparently intact with a dorsal vein. The thumb appeared dusky bluish and capillary refilling was absent. TreatmentThe proximal digital vessels were identified, but there were no distal digital arteries. A small branch of the radial digital artery supplying the dorsal skin was identified and anastomosed, but there was no improvement in circulation. Although anastomosis was patent, the thumb remained pale and cyanotic. After extensive searching, we found a small tortuous vena comitans on the ulnar side of the volar aspect distally and this was anastomosed with the ulnar digital artery. The thumb tip appeared pink on the table. The skin was approximated with only two sutures with minimum tension. There was good capillary refill.The small bony fragments and the distal half of the proximal phalanx were removed. The distal phalanx was fused to the remaining proximal phalanx in a "peg and socket" manner and fixed with Kirschner wire.The thumb remained pink and survived. Figure 2 shows the appearance of the revascularized thumb at three weeks postoperatively. DiscussionThe first arteriovenous anastomosis was originally described in 1896 by Francois Franck (Germann et al., 1987).1 But the details of surgical technique did not receive much attention until recently. A number of papers have described the concept of a flap with an afferent arteriovenous fistula. Some of these studies provided important but often conflicting information concerning the physiological effects of blood flow reversal in the venous system.

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“…31 Long-term arterial perfusion was not successful in his models. Nichter and Haines (1985) 32 reported good results of replanted canine ears without any peripheral vein. They anastomosed a distal ear artery end-to-end to a peripheral vein and achieved sufficient outflow.…”

Section: Historical Overviewmentioning

confidence: 96%

Concept of arteriovenous loupes in high‐risk free‐tissue transfer: history and clinical experiences

et al. 2004

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The present study describes the concepts of arteriovenous (A-V) loupes prior to microsurgical free flap transfer in a selected high-risk group of patients. A one-stage concept was employed in 26 patients; 5 patients underwent two-stage flap transfer. Seven thrombotic occlusions of the A-V fistula or flap vessels were recorded; 6 patients underwent successful revision. Overall flap survival was 96.8% and compared favorably to reports in the literature. Defect coverage could be achieved in all but one case. It can be concluded from the data that in selected high-risk patient groups, i.e., following radiation, compound trauma, chronic infection, or multiple comorbidities, the creation of an A-V fistula prior to flap transfer may facilitate innovative reconstructive solutions.

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Arterialized venous perfusion of composite tissue

Cited by 41 publications

References 36 publications

Microcirculation of a Venous Flap: An Experimental Study With Microspheres in Rabbits

Microcirculation of a Venous Flap: An Experimental Study With Microspheres in Rabbits

Afferent Arteriovenous Fistula in Thumb Revascularization

Concept of arteriovenous loupes in high‐risk free‐tissue transfer: history and clinical experiences

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