Importance of Vascularity and Selecting the Recipient Vessels of Lower Extremity Reconstruction

Hong, Joon Pio; Pak, Changsik John; Suh, Hyunsuk Peter

doi:10.1055/s-0040-1708835

Cited by 11 publications

(19 citation statements)

References 51 publications

(43 reference statements)

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“…This has been further promoted by Hong et al (2021). 12 Although we could not directly assess location of anastomosis in this study, the location of the point of anastomosis, whether proximal or distal to the wound, also bears consideration. In our current practice, we do have a preference for anastomosis location proximal to the area of injury to avoid possible areas of intimal damage and thrombosis.…”

Section: Discussionmentioning

confidence: 98%

Technical Variables in Lower Extremity Free Flap Reconstruction

Christensen

Ahn

Meulendijks

et al. 2023

J Reconstr Microsurg

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Background: Lower extremity free flap failure rates are higher than in other areas of the body. While prior studies assessed the effect of intraoperative technical variables, these generally investigated individual variables and did not examine relationships between the many individual technical decisions made during a free tissue reconstruction. Purpose: Investigate the effect of variation in intraoperative microsurgical techniques on flap outcomes in a diverse cohort of patients requiring lower extremity free flap coverage. Methods: Consecutive patients undergoing free flap reconstruction of the lower extremity at two level 1 trauma centers from January 2002 to January 2020 were identified using CPT codes, followed by review of medical records. Demographics and comorbidities, indications, intraoperative technical details, and complications were collected. Outcomes of interest included unplanned return to the operating room, arterial thrombosis, venous thrombosis, partial flap failure, and total flap failure. Bivariate analysis was performed. Results: 410 patients underwent 420 free tissue transfers. Median follow up time was 17 months (IQR 8.0-37). Total flap failure occurred in 4.9% (n=20), partial flap failure in 5.9% (n=24), and unplanned reoperation in 9.0% (n=37), with arterial thrombosis in 3.2% (n=13), and venous thrombosis 5.4% (n=22). Overall complications were significantly associated with recipient artery choice, with arteries other than PT and AT/DP having a higher rate (p=0.033), and with arterial revisions (p=0.010). Total flap failure was also associated with revision of the arterial anastomosis (p=0.035), and partial flap failure was associated with recipient artery choice (p=0.032). Conclusions: Many interoperative options and techniques are available when performing microvascular lower extremity reconstruction that lead to equally high success rates. However, use of arterial inflow outside of the posterior tibial and anterior tibial arteries leads to a higher overall complication rate and partial flap failure rate. Intraoperative revision of the arterial anastomosis portends poorly for ultimate flap survival.

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Section: Discussionmentioning

confidence: 98%

Technical Variables in Lower Extremity Free Flap Reconstruction

Christensen

Ahn

Meulendijks

et al. 2023

J Reconstr Microsurg

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“…Even in ischemic limb of diabetic foot, the collateral form as the main artery slowly undergoes arthrosclerosis and is able to supply adequate perfusion to the perforator despite flow obstruction in major arteries. 35,36,38,48 Of course there are limits to this approach, such as using it as a recipient vessel for a reasonable perforator flap and not for a large flap or a chimeric flap that requires abundance of inflow.…”

Section: Perforators As Recipientsmentioning

confidence: 99%

“…The exact definition of zone of injury still remains unclear and unreproducible. 37 38 However, this concept is clinically important as thrombogenic zone is known to extend beyond what is macroscopically evident and failure to recognize the true extent of this zone is cited as a leading cause of microsurgical anastomotic failure. 29 38 One logical approach would be to search the recipient vessel proximal or distal to the zone where the tissue would be less scarred and well preserved.…”

Section: Factors To Considermentioning

confidence: 99%

“…37 38 However, this concept is clinically important as thrombogenic zone is known to extend beyond what is macroscopically evident and failure to recognize the true extent of this zone is cited as a leading cause of microsurgical anastomotic failure. 29 38 One logical approach would be to search the recipient vessel proximal or distal to the zone where the tissue would be less scarred and well preserved. 39 40 41 42 43 44 45 Using the duplex ultrasound, one can evaluate the potential recipient within the zone of injury to measure the flow velocity and to see if there are supple or scarred tissue surrounding the potential recipient.…”

Section: Factors To Considermentioning

confidence: 99%

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Using Duplex Ultrasound for Recipient Vessel Selection

Hong

Kim

Pak

et al. 2022

J Reconstr Microsurg

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Introduction Among the many factors involved in reconstructive microsurgery, identifying a good recipient vessel is one of the key elements leading to a successful result. Material and Method Multiple modalities have been used to identify recipient vessels from simple palpation of axial arteries to hand-held Doppler, duplex ultrasound, computed tomography angiograms, and other advanced techniques. Although these various modalities bring their own unique advantages, using the duplex ultrasound can provide far superior and real-time information based on the anatomy and physiology of the recipient vessel. Result Duplex ultrasound is a valuable and powerful tool for reconstructive surgeons who are interested in performing microsurgery or supermicrosurgery. Conclusion As we enter the era of individualized/customized reconstruction using superthin flaps, perforator-to-perforator anastomosis, and supermicrosurgery, understanding and becoming versatile with duplex ultrasound will be critical especially in choosing recipient vessels.

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“…Surgery for involutional blepharoptosis (IB) is among the most frequently performed oculoplastic procedures worldwide. 1 2 3 4 5 Majority of Japanese plastic surgeons that use it tend to be most interested in eyelid fold contour, pretarsal show, and eyebrow height. IB treatment therefore tends to be categorized as “cosmetic” rather than “functional.” 6 7 …”

Section: Introductionmentioning

confidence: 99%

Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters

et al. 2022

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Background We investigate the effect of involutional blepharoptosis (IB) surgery based on dry eye symptoms by analysis using objective and subjective measures. Methods We recorded various parameters from patients that underwent levator advancement surgery for IB, totaling 125 eyes (total 65 patients, 5 unilateral, 60 bilateral). Subjective assessment comprised a questionnaire on dry eye-related quality of life score (DEQS), a summary score calculated from DEQS, and six-grade evaluation, the patient's own measure of eye comfort. Objective assessment comprised marginal-reflex distance-1 (MRD-1), measurement of tear film breakup time, and superficial keratopathy (SPK) existence by slit lamp microscope. Results Subjective assessments showed that IB patients had improvement of dry eye symptoms and eye comfort when surgery increased MRD-1. On the other hand, objective assessments showed that the presence of SPK is suspected when the postoperative MRD-1 level is 3 mm or higher. Conclusion IB surgery must not only increase MRD-1 value, but also to perform maintenance of the appropriate ocular surface condition. From our parameters, we suggest postoperative MRD-1 value should be maintained at < 3 mm to safe and effective of IB surgery.

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Importance of Vascularity and Selecting the Recipient Vessels of Lower Extremity Reconstruction

Cited by 11 publications

References 51 publications

Technical Variables in Lower Extremity Free Flap Reconstruction

Technical Variables in Lower Extremity Free Flap Reconstruction

Using Duplex Ultrasound for Recipient Vessel Selection

Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters

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