Flow changes in forearm arteries after elevating the radial forearm flap: prospective study using color duplex imaging.

Abstract

n reconstructive surgery, microvascular free tissue transfers have gradually evolved from being a procedure of last resort to becoming a first choice operation in the last two decades. For this reason, careful preoperative assessment of the vascular anatomy of both donor tissue pedicles and recipient vessels is mandatory when planning these reconstructive procedures, and CDI has proved to be very useful for this purpose. Many other CDI applications in reconstructive microsurgery have been introduced recently, 1 and its contribution in assessing the vascular morbidity of the radial forearm flap is presented in this paper. Use of the radial forearm flap, a fasciocutaneous flap supplied by the radial artery, is a versatile and reliable technique for different reconstructive problems. The aim of the present study is to assess the changes in flow patterns of forearm arteries caused by excision of the radial artery when harvesting the radial forearm flap to clarify the vascular morbidity. To this purpose, a prospective study was designed using CDI for preoperative and postoperative quantitative flow measurements in forearm arteries. The aim of the present study was to assess the changes in flow patterns of forearm arteries produced by excision of the radial artery when harvesting the radial forearm flap. A prospective study using color duplex imaging for quantitative flow measurements was accomplished in 11 patients. After raising the radial flap, the forearm flow tended to increase overall, the ulnar (P = 0.04), the posterior interosseous (P = 0.003), and the anterior interosseous (P = 0.003) arteries being responsible for this tendency. Therefore, harvesting of a radial flap must not be considered as causing vascular morbidity in terms of blood supply to the hand. KEY

Evaluation of radial and ulnar blood flow after radial artery cannulation with 20‐ and 22‐gauge cannulae using duplex Doppler ultrasound

“…In a study by Brodman et al., radial artery harvest induced an immediate increase of ulnar artery diameter (15.7%) and flow velocity (17.4%) [9]. Meanwhile, ulnar artery blood flow was shown to increase significantly for a few months to 10 years after radial artery removal [10, 11], indicating a chronic increase in ulnar artery flow in the absence of radial artery flow. Interestingly, in 10 patients (four in the 20‐G cannula group and six in the 22‐G cannula group) from our study, PSV, EDV and MVF of the ulnar artery were decreased immediately after radial artery cannulation.…”

In vivo quantitation of rare circulating tumor cells by multiphoton intravital flow cytometry

“…First, because an average 70-kg cancer patient will have Ϸ5 liters of blood, interrogation of the patient's entire blood volume will require at least Ϸ1 h assuming the blood vessel under observation has a diameter of 3 mm and flows at a rate of Ϸ100 ml/min (27). Although it can be argued that a patient's entire blood volume need not be interrogated, methods will still have to be developed to maintain the desired blood vessel in focus for the desired duration of the assay.…”

Intraoperative Hemodynamic Evaluation of the Radial and Ulnar Arteries during Free Radial Forearm Flap Procedure

“…The role of the anterior interosseous artery in collateral circulation of the hand has been well recognized also by other authors, 3,15,16 and it has also been shown that excision of the radial artery leads to compensatory changes in the ulnar, posterior interosseus, and anterior interosseus arteries that may in turn guarantee a good vascularization to the hand and may exert a protective effect for potential ischemia. 15 In our intraoperative study, the flow of both anterior and posterior interosseous arteries were not registered as they were not harvested during the operation; dissecting at the origin the ulnar artery and more deeply the interosseous vessels for locating the probe could have impaired the arteries and the vascularization of the hand.…”