Effects of Tissue Component Volumes on Vascular Resistance in Free Flaps

Ono, Masashi; Takanari, Keisuke; Toriyama, Kazuhiro; Yagi, Shunjiro; Ebisawa, Katsumi; Sawamura, Hisashi; Kambe, Miki; Murotani, Kenta; Kamei, Yuzuru

doi:10.1055/s-0036-1588004

Cited by 4 publications

(7 citation statements)

References 10 publications

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“…Consultation with a vascular surgeon for preoperative arteriography cannot be overemphasized 23,24 . Long-term patency of microvascular anastomosis is dependent on the arterial and venous flow within the flap 6 . Preoperative planning with a vascular surgeon is crucial to select a patent, high-caliber recipient artery for flap anastomosis 14,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Free tissue transfer reconstruction of soft tissue defects has been shown to provide additional blood supply to wounds, which promotes healing and resists infection at the recipient site 4,5 . Previously, the blood supply within these flaps has been shown to be a critical determinant for the patency of the microvascular anastomosis 6 …”

mentioning

confidence: 99%

“…Generally, patients with chronic LE wounds have multiple medical comorbidities, such as peripheral arterial disease (PAD) and diabetes mellitus, which can negatively impact wound healing 7,8 . In these patients, especially those with PAD, it is crucial that reconstructive surgeons choose flaps with adequate blood flow, because these patients often suffer from low-flow, high-resistance perforators 6 . Furthermore, in patients with PAD, FTT to the LE may be challenging due to limited vessel supply for free flap anastomosis.…”

mentioning

confidence: 99%

“…4,5 Previously, the blood supply within these flaps has been shown to be a critical determinant for the patency of the microvascular anastomosis. 6 Generally, patients with chronic LE wounds have multiple medical comorbidities, such as peripheral arterial disease (PAD) and diabetes mellitus, which can negatively impact wound healing. 7,8 In these patients, especially those with PAD, it is crucial that reconstructive surgeons choose flaps with adequate blood flow, because these patients often suffer from low-flow, high-resistance perforators.…”

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confidence: 99%

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Long-Term Outcomes in Patients With Peripheral Arterial Disease Who Undergo Free Flap Reconstruction for Chronic Lower Extremity Wounds

et al. 2023

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Background Free tissue transfer (FTT) is critical for limb salvage of chronic lower extremity (LE) wounds. In patients with peripheral arterial disease (PAD), FTT LE reconstruction can be challenging due to limited vessel selection for anastomosis. The study aims to evaluate our surgical and functional outcomes after FTT to LE in patients with PAD. Methods A retrospective review identified patients who underwent LE free flap reconstruction between 2011 and 2021. All patients underwent preoperative arteriogram and subsequent FTT. Patients were classified into PAD or non-PAD cohorts, based on the presence of LE arterial stenoses or occlusions identified on arteriogram. Primary outcomes included complications, flap success, need for post-FTT vascular reintervention, limb salvage, and ambulatory status. Results A total of 253 patients underwent FTT to LE, with 84 patients (33.2%) in the PAD cohort. Patients with PAD had a higher prevalence of diabetes (83.3% vs 39.1%, P < 0.001) and end-stage renal disease (8.3% vs 2.4%, P = 0.028). Osteomyelitis was more common in the PAD group (73.8% vs 55.0%, P = 0.004). Free tissue transfer donor sites and flap composition were similar between cohorts. At a mean follow-up of 21.1 months, limb salvage rates were similar between non-PAD and PAD cohorts (90.5% vs 84.5%, P = 0.158), with no significant differences in ambulatory status or mortality. Higher complication rates occurred in the PAD cohort (38.1% vs 20.7%, P = 0.003), of which partial flap necrosis was more prevalent in the PAD group (6.0% vs 0.6%, P = 0.016). There was no difference in flap success rates between groups (P = 0.430). More postflap angiograms were performed in the PAD group (29.8% vs 7.1%, P < 0.001), with repeat percutaneous endovascular intervention performed in 68.0% of the PAD group versus 33.3% of the non-PAD group (P < 0.001). Conclusions This is the largest study to demonstrate excellent long-term limb salvage outcomes in patients with PAD who undergo FTT to LE. Percutaneous endovascular intervention and FTT are effective methods to achieve limb salvage in vasculopathic patients with chronic LE wounds.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Long-Term Outcomes in Patients With Peripheral Arterial Disease Who Undergo Free Flap Reconstruction for Chronic Lower Extremity Wounds

et al. 2023

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“…In the subgroup analysis of perforator and musculocutaneous flaps, the significant differences in the volumetric flow rate and pulsatility index of perforator and musculocutaneous flaps in end-to-end anastomosis are explained by the fact that musculocutaneous flaps have a larger vascular bed and greater blood capacity compared with perforator flaps. [33][34][35] The flap (skin paddle) size of the musculocutaneous flap was significantly larger than that of the perforator flap, which implied that the differences in the volumetric flow rate and pulsatility index could be confounded by the volume of the skin paddle or fat. However, the results of the subgroup analysis were considered valid because the two groups could be regarded as a "low-volume flap" (small skin paddle and no muscle) group and a "high-volume flap" (large skin paddle and muscle) group.…”

Section: Flow-throughmentioning

confidence: 99%

A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study

Kagaya

Arikawa

Akazawa

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Background:The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and endto-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined. Methods: Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state).Results: In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 ± 14.1 ml/ minute versus 6.0 ± 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 ± 3.7 versus 13.6 ± 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values. Conclusion:In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements.

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A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients

et al. 2023

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Objective: Chronic lower extremity (LE) wounds are common in patients with peripheral vascular disease (PVD). Free tissue transfer (FTT) provides healthy soft tissue for wound coverage and additional blood supply to promote wound healing. Given previous studies demonstrate increased complications in LE fasciocutaneous flaps, it was hypothesized that low vascular resistance in muscle flaps may be more advantageous for wound healing in PVD patients. Therefore, this study compared outcomes in PVD patients undergoing LE reconstruction with fasciocutaneous versus muscle free flaps. Methods: Retrospectively reviewed PVD patients undergoing FTT between 2011 and 2021. Patients were stratified into fasciocutaneous and muscle free flap groups. Primary outcomes included complications, flap success, post-reconstruction vascular interventions, limb salvage, and ambulatory status. Results: One hundred thirteen patients with PVD were identified, of which 60.2% received fasciocutaneous (n = 68) and 39.8% received muscle flaps (n = 45). Fortytwo patients (37.2%) underwent pre-flap endovascular interventions. Flap success rate was 98.2% (n = 111). Overall complication rate was 41.2% following fasciocutaneous flaps compared to 24.4% in muscle flaps (p = 0.067). Fasciocutaneous flaps had higher odds of ulceration requiring repeat angiogram within 1 year of reconstruction compared to muscle flaps (OR 3.4, 95%

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Effects of Tissue Component Volumes on Vascular Resistance in Free Flaps

Cited by 4 publications

References 10 publications

Long-Term Outcomes in Patients With Peripheral Arterial Disease Who Undergo Free Flap Reconstruction for Chronic Lower Extremity Wounds

Long-Term Outcomes in Patients With Peripheral Arterial Disease Who Undergo Free Flap Reconstruction for Chronic Lower Extremity Wounds

A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study

A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients

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