Arteriovenous Fistula and Skin Flaps

Yenidünya, Mehmet Oğuz; Yilmaz, Sarper

doi:10.1055/s-2007-1000137

Cited by 12 publications

(14 citation statements)

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“…On the other hand, it has already been shown that an arteriovenous fistula proximal to the pedicle is a real threat for groin island flap survival in a rat model. 11 In Group 1, by elevating an island flap with an end-to-end arteriovenous anastomosis distal to the pedicle, we did not observe any increase in blood flow through the skin flap. Also there was no edema formation on the skin surface.…”

Section: Discussionmentioning

confidence: 57%

Different Types of Arteriovenous Anastomoses between Femoral Artery and Vein Distal to the Island Groin Flap

Yenidünya¹,

Yenıdünya²,

Suse³

et al. 2002

J reconstr Microsurg

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An experimental study was done in rats in which the animals were randomly divided into four groups. Each group included bilateral standard island groin flaps. The right side flap was used as control. On the left side, after elevation of the flap, different types of arteriovenous connections were constructed distal to the pedicle between the femoral artery and vein. The connection type was a type-C (end-to-end) anastomosis in Group 1; a type-X (side-to-side) anastomosis in Group 2; a type-T a (artery-end-to-vein-side) anastomosis in Group 3; and a type-Tv (vein-end-to-artery-side) anastomosis in Group 4. Flow values in the flaps were measured externally and repeatedly using a laser Doppler flowmeter. Extremity changes, signs of congestive heart failure, flap weights (measured at the end of the study), thrombosis at the anastomosis or distal to it, edema in the flaps, subcutaneous venous stasis, and aneurysm formation in the anastomoses were observed. Histopathologic evaluations were also done. Only the side-to-side anastomosis group showed any aneurysm formation in the distal vein, as well as extremity changes and signs of congestive heart failure in some of the animals. Only the artery-end-to-vein-side group showed distal thromboembolism in some animals. All flaps survived, but there was prominent edema in the flaps of Group 2 and Group 4 animals in decreasing order. All the study flaps demonstrated subcutaneous venous stasis and capsule formation. The authors concluded that although any arteriovenous communication located distal to the pedicle of an island skin flap that connects the arterial to the venous system, bypassing microcirculation, may have some beneficial effects, it is not devoid of some possibly hazardous developments, including edema formation and venous stasis.

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Section: Discussionmentioning

confidence: 57%

Different Types of Arteriovenous Anastomoses between Femoral Artery and Vein Distal to the Island Groin Flap

Yenidünya¹,

Yenıdünya²,

Suse³

et al. 2002

J reconstr Microsurg

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“…This flap has been used in many different shapes and sizes and has been utilized in numerous metabolic, hemodynamic, immunologic, biochemical, and physiologic studies in flap research. 10,[17][18][19][20][21][22][23][24][25] Normally, the femoral vessels are used for suturing because of their much larger diameter in comparison to the epigastric vessels. 3,15,16,22,23,26 The length of the vascular pedicle, the epigastric vessels with or without the femoral part within, allows a transfer to the neck of the rat.…”

Section: Discussionmentioning

confidence: 99%

Intraoral coverage of defects with the superficial epigastric fat flap in rats

et al. 2008

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The standard superficial epigastric artery flap has become a reliable model for flap research. The purpose of this study was to design a flap model in the rat, with the possibility of intraoral coverage of defects. A fat flap based only on the medial trunk of the superficial epigastric vessels was generated, raised to the neck, and used for the coverage of a created intraoral defect in 28 Sprague-Dawley rats. Twenty-five epigastric flaps were raised and anastomosed to the neck, and three flaps were sutured into the oral cavity as a control without anastomosing the vessels to the rat's neck. For histological examination, each of the five flaps was harvested after 7, 14, and 35 days. A total of five rats died perioperatively, and 23 rats survived. One epigastric fat flaps became necrotic, which attracted attention by dehiscence after 3 or 4 days postoperatively, consisting of one anastomosed and all nonvascularized flaps. A swollen cheek was noted in these cases after about 5 days. Although this model demands the control of basic microsurgical techniques, it is possible to use it as a training model for further refining microsurgical techniques in flap raising. It is planned to use this flap as a model for healing purposes in the oral cavity.

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“…It was concluded that island skin flap circulation is negatively affected by an AVF proximal to the flap pedicle. 18 …”

Section: Discussionmentioning

confidence: 99%

Difficult Femoral Arteriovenous Fistula in a Child

Khougeer

2000

Ann Saudi Med

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G Khougeer, AHB Okda, Difficult Femoral Arteriovenous Fistula in a Child. 2000; 20(2): 150-152 An arteriovenous (AV) fistula is an abnormal communication between the arterial and venous systems, and can be congenital or acquired. The majority of peripheral fistulas are the result of trauma.1,2 The extent of clinical manifestations is related to the size, duration, and the precise location of the fistula, varying from local changes to central changes due to stress on the entire cardiovascular system. Chronic peripheral fistulas are typically associated with dilatation and elongation of the feeding artery, 4 as well as proximal dilatation of the venous system. Venous hypertension, valve incompetence, and venous hypertrophy commonly lead to distal swelling, dermatitis and ulceration, similar to that seen in the post-phlebitic state (Figure 1).Although physical diagnosis is easy when these fistulas are located in the extremities, arteriography is important in delineating the anatomy in order to plan the appropriate management of the patient. However, with the invasive techniques currently available, there should be few chronic traumatic AV fistulas in the practice of vascular surgery. 5 Case ReportA three-year-old girl presented with skin ulcer over the left lower leg, which had been debrided several times and skin grafted (Figure 1). The patient was the product of a 32-week gestation pregnancy, and was admitted to the nursery unit. She was diagnosed with left leg lymphangiectasia, based on previous clinical positive lymphangiography findings and recurrent cellulitis. During one of the debridement sessions of the leg ulcer, considerable bleeding occurred which required suturing. The suspicion of AV malformation was raised when MRI showed significant dilated vessels, both superficial and intramuscular. The patient was referred to the vascular surgery service.Physical examination showed an ill-looking child with low-grade fever, but normal cardiorespiratory system. Abdominal examination was also normal. The whole left lower limb was swollen (Figure 1). There was no sign of a previous injury in the left groin, but there was evidence of dermatitis and ulcer on the lower medial aspect of the leg. A thrill and murmur were elicited over the femoral vessels.

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Arteriovenous Fistula and Skin Flaps

Cited by 12 publications

References 0 publications

Different Types of Arteriovenous Anastomoses between Femoral Artery and Vein Distal to the Island Groin Flap

Different Types of Arteriovenous Anastomoses between Femoral Artery and Vein Distal to the Island Groin Flap

Intraoral coverage of defects with the superficial epigastric fat flap in rats

Difficult Femoral Arteriovenous Fistula in a Child

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