Impact of active thermoregulation on the microcirculation of free flaps

Dornseifer, Ulf; Fichter, Andreas M.; Isenburg, Sarah von; Stergioula, Sofia; Rondak, Ina-Christine; Ninković, Milomir

doi:10.1002/micr.22523

Cited by 13 publications

(9 citation statements)

References 44 publications

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“…Despite the inclusion of a large study population from a high-volume center and the use of an established measurement method, this study has limitations. It should be mentioned that a moist environment, owing to salivary flow and wound secretion, can aggravate the measurements, and that skin temperature, as skin perfusion depends on skin temperature, also affects the measurements 35 , 36 . An influence on the measurement by the moist environment is particularly pronounced for intraoral flaps; however, flap blood flow did not differ between intraoral flaps and extraoral flaps.…”

Section: Discussionmentioning

confidence: 99%

Smoking and microvascular free flap perfusion in head and neck reconstruction: radial free forearm flaps and anterolateral thigh flaps

Ooms

Puladi

Houschyar

et al. 2022

Sci Rep

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Head and neck reconstruction with microvascular free flaps is frequently performed in smokers. Smoking causes various alterations in the cardiovascular system. The aim of this study was to investigate the effects of smoking on flap perfusion as a critical factor for flap survival. A total of 370 patients reconstructed with a radial free forearm flap (RFFF) or anterolateral thigh flap (ALTF) in the head and neck region between 2011 and 2020 were retrospectively analyzed. Flap perfusion measurements with the O2C tissue oxygen analysis system were compared between nonsmokers, light smokers (< 20 pack-years), and heavy smokers (≥ 20 pack-years). The blood flow was intraoperatively equal in RFFFs (84.5 AU vs. 84.5 AU; p = 0.900) and increased in ALTFs (80.5 AU vs. 56.5 AU; p = 0.001) and postoperatively increased in RFFFs (114.0 AU vs. 86.0 AU; p = 0.035) and similar in ALTFs (70.5 AU vs. 71.0 AU; p = 0.856) in heavy smokers compared to nonsmokers. The flap survival rate was similar in nonsmokers, light smokers, and heavy smokers (97.3%, 98.4%, and 100.0%). Smoking partially increases rather than decreases microvascular free flap perfusion, which may contribute to similar flap survival rates in smokers and nonsmokers.

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Section: Discussionmentioning

confidence: 99%

Smoking and microvascular free flap perfusion in head and neck reconstruction: radial free forearm flaps and anterolateral thigh flaps

Ooms

Puladi

Houschyar

et al. 2022

Sci Rep

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“…In 2015, Dornseifer et al 26 assessed temperature in 25 perforator flaps using implantable probe. They used water circulation-based system for external warming of the flaps.…”

Section: Discussionmentioning

confidence: 99%

Importance of Postoperative Use of External Warming Devices in Flap Reconstructive Surgery

Maklad

Emam²

2022

Journal of Hand and Microsurgery

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Flap failure, partial or complete, can have great negative impact on the patient and the reconstructive outcome. The effect of thermal regulation on flap survival is well recognized. This article focuses on the importance of external warming devices as a standard on postoperative flap care to avoid any temperature-related vascular compromise. PubMed, Medline, and EMBASE search had been performed. More than 60 papers have been reviewed. Out of them, that 29 references have been included in this review. The authors emphasize on the importance of strict postoperative flap temperature control with active warming devices as a standard of practice to minimize any related microcirculatory changes.

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“…Current hypotheses include vascular dilation of choke vessels and reorganization, sympathetic denervation, neovascularization through angiogenesis and vasculogenesis (although this short time frame does not allow for completion from the flap pedicle), metabolic adaptation to hypoxia and ischemia, and intracellular mediators. 6 – 14 Given the drawbacks of 2-stage surgical preconditioning, recent work has focused on alternative nonsurgical delay techniques such as thermoregulation 15 and preconditioning using pharmacologic agents such as adenoviral and acute vasodilatory vectors. 16 , 17 These other delay procedures are routinely compared with surgical delay as a gold standard, yet no study has performed a standardized comparison of the 2 most common types of surgical delay techniques.…”

Section: Introductionmentioning

confidence: 99%

The Delay Phenomenon: Is One Surgical Delay Technique Superior?

Gersch

Fourman

Dracea

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Surgical delay remains a common method for improving flap survival. However, the optimal surgical technique has not been determined. In this article, we compare flap perfusion, viable surface area, and flap contraction of 2 surgical delay techniques.Methods:Male Sprague-Dawley rats were divided into 3 groups. In the incisional surgical delay group (n = 9), a 9 × 3 cm dorsal flap was incised on 3 sides without undermining, leaving a cranial pedicle. In the bipedicle surgical delay group (BSD, n = 9), a 9 × 3 cm dorsal flap was incised laterally and undermined, leaving cranial and caudal pedicles. Control group (n = 16) animals did not undergo a delay procedure. Ten days following surgical delay, all flaps for all groups were raised, leaving a cranial pedicle. A silicone sheet separated the flap and the wound bed. On postoperative day (POD) 7, viable surface area was determined clinically. Contraction compared to POD 0 was measured with ImageJ software. Perfusion was measured with Laser Doppler Imaging. The Kruskal-Wallis with Dunn’s multiple comparisons test was performed for group comparisons.Results:BSD preserved significantly more viable surface area on POD 7 (13.7 ± 4.5 cm2) than Control (8.7 ± 1.8 cm2; P = 0.01). BSD also showed significantly less contraction (21.0% ± 13.5%) than Control (45.9% ± 19.7%; P = 0.0045). BSD and incisional surgical delay showed significantly increased perfusion compared with Control on POD 0 (P = 0.02 and 0.049, respectively), which persisted on POD 3. This trend resolved by POD 7.Conclusion:BSD showed improved early perfusion, increased viable surface area, and reduced contraction compared to control, suggesting that BSD is the superior flap design for preclinical modeling.

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Impact of active thermoregulation on the microcirculation of free flaps

Abstract: Active thermoregulation using water-based circulation is an effective and safe procedure to improve microcirculation in free flaps and is superior to conventional passive warming strategies.

Cited by 13 publications

References 44 publications

Smoking and microvascular free flap perfusion in head and neck reconstruction: radial free forearm flaps and anterolateral thigh flaps

Smoking and microvascular free flap perfusion in head and neck reconstruction: radial free forearm flaps and anterolateral thigh flaps

Importance of Postoperative Use of External Warming Devices in Flap Reconstructive Surgery

The Delay Phenomenon: Is One Surgical Delay Technique Superior?

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