Comparing Various Surgical Delay Methods with Ischemic Preconditioning in the Rat TRAM Flap Model

Cinpolat, Ani; Bektas, Gamze; Coşkunfırat, Nesil; Rizvanoviç, Zumreta; Coşkunfırat, O. Koray

doi:10.1055/s-0033-1363326

Cited by 12 publications

(11 citation statements)

References 33 publications

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“…Partial or total flap necrosis remains a major challenge in the field of pedicled flap surgery. The surgical delay has been demonstrated to be a reliable procedure to improve pedicled flap's survival area, but so far, the optimal delay period is still a controversial issue, which may be 5 days, 7 days, 14 days, 21 days, or 8–10 days in the literature . Thus, how to determine the optimal delay time continues to be unknown in the clinical practice, because various surgical delay animal models and delay procedures may significantly influence the delay period of reaching the maximal delay effect .…”

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confidence: 99%

Visualized identification of the maximal surgical delay effect in a rat flap model

Chen

Jiang

et al. 2018

Wound Repair Regeneration

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Currently, experimental evidence suggests that the surgical delay can increase flap survival area, but its effect may decrease if the optimal delay period is missed. The aim of this study is to establish a sensitive and objective modality based on the visualized and individualized infrared thermography for identifying the maximal surgical delay effect. A rectangular three‐angiosome flap was designed on the unilateral dorsum of the rat. Ninety‐six rats were randomly divided into six groups according to the various delay time. Both the relative temperature and the relative temperature ratio were measured by the infrared thermography. Arterial density, number of vessels >0.1 mm in diameter, microvessel density, VEGF concentration, and flap viability were measured. Receiving operating characteristic curve with the highest Youden‐Index was used to detect and identify an optimal cutoff point of the relative temperature ratio in the maximal surgical delay effect. The criteria for identifying the flap maximum delay effect based on the infrared thermography included the surface of the postdelayed flaps presented white color (higher temperature) instead of the red and white pattern of the normal skin and the optimal cutoff point of the relative temperature ratio was ≥1.17 with a sensitivity of 84.6% and a specificity of 77.3%. Instead, the sensitivity and specificity of the conventional method based on the delay time were 38.5 and 90.9%, respectively. Infrared thermal imaging can accurately identify the maximum delay effect when combined with the relative temperature ratio.

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confidence: 99%

Visualized identification of the maximal surgical delay effect in a rat flap model

Chen

Jiang

et al. 2018

Wound Repair Regeneration

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“…11 Various successful results have been published using the cross-leg method. [19][20][21][22][23][24][25][26][27][28][29][30] Yu et al published an 85-case series using the cross-bridge method and reported a success rate of 95.29%. 20 The advantages of reconstruction with cross-leg free flaps include the possibility of preparation with the required tissue components such as bone and muscle of the requisite sizes and allowing the anastomosis line to be completely outside the trauma zone.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported that the ischemic preconditioning for the early division of a flap's vascular pedicle can be applied extensively with minimal discomfort. 26,32 This is also an option for surgeons to consider. In theory, all types of free flaps can be applied in cross-leg free flaps.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Özkan

Cinpolat

Bektas

et al. 2016

J Reconstr Microsurg Open

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Background?The absence of suitable adjacent recipient vessels for microvascular anastomosis due to trauma poses a major challenge to the reconstructive surgeon. The anterior and posterior tibial vessels of the contralateral leg are the two other alternatives for use as recipient vessels for microvascular anastomosis. This method is known as the cross-leg free flap. Methods?Twenty-seven patients (20 males, 7 females) underwent cross-leg free flap operations due to absence of a suitable adjacent recipient vessel between 2007 and 2015. The mean soft tissue defect dimension was 12???11 cm (smallest: 6???7 cm; largest: 20 ?14 cm). Gustilo type 3B tibia fractures were present in 19 patients, but no fractures were present in the other 8. Six different flaps were used: 14 anterolateral thigh flaps, 6 latissimus dorsi flaps, 3 gracilis muscle flaps, 2 vastus lateralis musculocutaneous flaps, 1 tensor fascia latae flap, and 1 deep inferior epigastric perforator flap. Results?Two anterolateral thigh flaps failed, while the rest of the flaps survived completely. There were no donor-site complications. Conclusion?We think that the cross-leg free flap method can be safely and successfully used with all flap types in complex lower extremity injuries in which the adjacent recipient vessel option is unavailable.

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“…Reperfusion injury by abrupt restoration of circulation after the prolonged ischemia has long been a big problem in plastic and reconstructive surgery. 9 Multiple therapeutic strategies have been proposed in an attempt to attenuate I/R injury, 22,34,35 among which the post-con procedure is the one that has been investigated as the most promising protocol. post-con was first described in 1996, which involves intermittent cycle reperfusion after ischemic insult.…”

Section: Discussionmentioning

confidence: 99%

The Value of Postconditioning in Plastic and Reconstructive Surgery: A Systematic Review

Weng

Zhang

Lineaweaver

et al. 2016

J reconstr Microsurg

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Background Ischemia-reperfusion (I/R) injury by abrupt restoration of circulation after prolonged ischemia has still been an unsolved problem in plastic and reconstructive surgery. The concept of postconditioning (post-con), which has been well described in cardiovascular surgery, has been recently introduced in plastic and reconstructive surgery. As an "after-injury strategy," post-con may be a promising approach to reduce I/R injury and improve flap survival after ischemia. Methods A systematic review was performed by searching electronic databases of PubMed and web of science to identify all the studies regarding the application of the post-con technique in plastic and reconstructive surgery between 1950 and 2015. Inclusion criteria were English articles with clear reporting the post-con techniques and detailed outcomes. Results In total, 476 articles were identified and 18 studies reporting post-con in plastic and reconstructive surgery met the inclusion criteria in this review, including 11 studies of mechanical post-con, 3 studies of pharmacological post-con, 1 study of both mechanical and pharmacological post-con, and 3 studies of remote post-con. All these studies reported protective effects of any kind of post-con techniques in I/R injuries and could improve flap survivals. Conclusion In general, the strategy of post-con may effectively reduce I/R injury and improve the survival of flaps after ischemia in animal studies, yet no consensus regarding the exact technical details (intervention timing, cycles, intermittent duration, etc.) has been reached. Further studies aiming to explore its mechanisms as well as specific methodology are required before clinical application in plastic and reconstructive surgery.

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Comparing Various Surgical Delay Methods with Ischemic Preconditioning in the Rat TRAM Flap Model

Cited by 12 publications

References 33 publications

Visualized identification of the maximal surgical delay effect in a rat flap model

Visualized identification of the maximal surgical delay effect in a rat flap model

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

The Value of Postconditioning in Plastic and Reconstructive Surgery: A Systematic Review

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