Direct in Vivo Observations of Embolic Events in the Microcirculation Distal to a Small-Vessel Anastomosis

Acland, Robert D.; Anderson, Gary L.; Siemionow, Maria; McCabe, Steven; Eriksson, Elof

doi:10.1097/00006534-198908000-00016

Cited by 17 publications

(22 citation statements)

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“…The major insult to the tissue was not ischemia and reperfusion, as the ischemia time chosen is not long enough to initiate the corresponding mechanisms. The major insult was, instead, the injury to the pedicle artery, which generates platelet emboli from the thrombogenic arterial injury passing down into the microcirculation [4,5]. If the ischemia time chosen had been longer, we could not have excluded a different behavior in the microcirculation, observed by other researchers.…”

Section: Discussionmentioning

confidence: 98%

“…Previous work with this model involved producing a technically poor vessel repair of the pedicle artery (iliac artery) upstream from the cremaster muscle and subsequent observation of the muscle microcirculation downstream from the anastomosis [4]. These studies demonstrated showers of platelet emboli and large numbers of adherent leukocytes in the microvessels following the anastomotic repair.…”

Section: Introductionmentioning

confidence: 99%

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Effect of granulocytes on the microcirculation in free-flap surgery

Peter

Steinau²,

Barker

1998

Langenbeck's Archives of Surgery

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Effect of granulocytes on the microcirculation in free-flap surgery

Peter

Steinau²,

Barker

1998

Langenbeck's Archives of Surgery

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“…Stagnation of blood within the free tissue transfer could also be responsible of the no-reflow phenomenon either by increasing the hyperpermeability of the microcirculation [11] or by increasing the rate of thrombosis [4]. One other factor that could influence the perfusion of tissue are the embolic events observed following microvascular anastomoses [1].…”

Section: Discussionmentioning

confidence: 99%

Early microscopic evidence for endothelial damage in arterial microanastomoses

et al. 2003

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Thrombosis of the arterial microanastomosis is the major reason for flap complications. Thrombus formation can occur rapidly at the site of anastomosis, or it may be delayed in developing, inducing secondary ischemia. The damaged endothelial cells and the exposed connective tissue play an important role in the molecular and cell mechanisms of coagulation and thrombosis. For this reason the early morphological changes in the endothelial cell layer after arterial microanastomoses in the rat were investigated. The results showed that the anastomotic site appeared completely sealed, with cut ends protruding into the vessel lumen. Extensive deendothelialized areas with fibrin deposition were visible between surgical microclamps on the inner surface of the artery. For this reason we believe that the damaged endothelium and exposed connective tissue elements are the primary cause of thrombin formation, platelet accumulation, and thrombosis at the anastomotic site. The reconstructive surgeon must employ a very meticulous microvascular technique to minimize damage to the vascular endothelium.

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“…This model thus has a broad range of potential applications, not only in microvascular surgery research but also in thrombosis research in general. Overall modern microcirculation models have a broad range of potential applications and enable an understanding of pathophysiologic mechanisms of thromboembolic injuries [67,68], which might lead to improved pharmacologic control of these mechanisms.…”

Section: Microcirculatory Consequences Of Microvascular Surgerymentioning

confidence: 99%

Microcirculation Research for Microsurgeons: Basic Concepts and Potential Applications

et al. 2001

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The primary purpose of this review is to introduce the techniques of modern microcirculation research to reconstructive microsurgeons and trauma surgeons. When applied to clinically relevant situations, these techniques are powerful tools to elucidate the mechanisms regulating success or failure of a reconstructive procedure. Several phenomena at the microcirculatory level can have significant influence on the outcome of free flaps or replants. Most importantly these are ischemia/reperfusion injury, problems with wound healing and failure of downstream microcirculation due to thrombosis at the vascular anastomosis.Traditional research methods to assess free flap or replant failure utilize patency of the repaired vessel as the principal parameter. This all-or-nothing measurement provides little information about the dynamic mechanisms regulating thrombosis and microcirculation in general.Modern microcirculation research techniques, in contrast, permit direct visualization with qualitative and quantitative analysis of microcirculation in vivo.Applying these modern research techniques in model systems that simulate clinical reconstructive microsurgery has the potential to expand our understanding of the relevance of blood flow and its alterations to clinical outcomes. To enable such an understanding, this review focuses on elucidating the basic nomenclature used in microcirculation research in context of microvascular problems clinically encountered by reconstructive and trauma surgeons.

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Direct in Vivo Observations of Embolic Events in the Microcirculation Distal to a Small-Vessel Anastomosis

Cited by 17 publications

References 0 publications

Effect of granulocytes on the microcirculation in free-flap surgery

Effect of granulocytes on the microcirculation in free-flap surgery

Early microscopic evidence for endothelial damage in arterial microanastomoses

Microcirculation Research for Microsurgeons: Basic Concepts and Potential Applications

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