Mathematical explanation of the buckling of the vessels after twisting of the microanastomosis

Selvaggi, Gennaro; Anicic, Sylvia; Formaggia, Luca

doi:10.1002/micr.20281

Cited by 35 publications

(21 citation statements)

References 8 publications

(24 reference statements)

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“…Once all perforators have been identified, the best one is chosen based on caliber, pulsatility, course and orientation, number and caliber of accompanying veins, and proximity to the defect and to a sensory nerve (the biggest perforators usually accompany sensory nerves all over the body). Then, in cases of suprafascial dissection, the fascial opening is widened and the perforator is freed from any surrounding tissue and dissected as long as possible (up to the source vessel) in order to achieve an adequate length of the pedicle along which to distribute the torsion [17]. Care should be taken in order to divide any attachment of the perforator to the surrounding tissues, like side branches (that must be ligated and not cauterized to avoid thermal damage to the perforator) or fibrous bands.…”

Section: Resultsmentioning

confidence: 99%

Propeller Flaps: A Review of Indications, Technique, and Results

D’Arpa

Toia

Pirrello

et al. 2014

BioMed Research International

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In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors' experience. Details about surgical technique are provided, together with tips to avoid and manage complications.

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Section: Resultsmentioning

confidence: 99%

Propeller Flaps: A Review of Indications, Technique, and Results

D’Arpa

Toia

Pirrello

et al. 2014

BioMed Research International

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“…In vitro studies have been less convincing, with equivocal results regarding the degree of kinking that leads to "buckling" and thrombosis (Level V Evidence). [111][112][113][114] In vivo studies show that kinking has a much greater impact in veins as opposed to arteries. Several retrospective reviews of free flap failure have shown that kinking or compression has resulted in venous thrombosis in each series of patients (Level III Evidence).…”

Section: Kinking Vein Grafts and One Versus Two Veinsmentioning

confidence: 97%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

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“…The human GSVs are more muscular, becomes increasingly inextensible with small increases in stretch or pressure, and have a greater thickness-to-radius ratio compared to the porcine IJVs which composed primarily of elastin and collagen, exhibits greater compliance in both the axial and circumferential directions. The effect of axial stretch ratio on vein twist has not been reported previously since it was not measured in previous studies (Endean et al 1989; Bilgin et al 2003; Selvaggi et al 2006). Our results showed that the axial stretch ratio has only modest effect on the critical twist angle of porcine veins.…”

Section: Discussionmentioning

confidence: 82%

“…The current results demonstrated that the two-fiber model can be used for blood vessel twisting deformation as well as (symmetric) inflation and axial stretch. It is also a big step forward as compared to previous vessel buckling simulations that used only the elastic isotropic material models (Selvaggi et al 2006; Wong et al 2007)…”

Section: Discussionmentioning

confidence: 99%

Twist buckling of veins under torsional loading

Garcia

Sanyal

Fatemifar

et al. 2017

Journal of Biomechanics

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Veins are often subjected to torsion and twisted veins can hinder and disrupt normal blood flow but their mechanical behavior under torsion is poorly understood. The objective of this study was to investigate the twist deformation and buckling behavior of veins under torsion. Twist buckling tests was performed on porcine internal jugular veins (IJVs) and human great saphenous veins (GSVs) at various axial stretch ratio and lumen pressure conditions to determine their critical buckling torques and critical buckling twist angles. The mechanical behavior under torsion was characterized using a two-fiber strain energy density function and the buckling behavior was then simulated using finite element analysis. Our results demonstrated that twist buckling occurred in all veins under excessive torque characterized by a sudden kink formation. The critical buckling torque increased significantly with increasing lumen pressure for both porcine IJV and human GSV. But lumen pressure and axial stretch had little effect on the critical twist angle. The human GSVs are stiffer than the porcine IJVs. Finite element simulations captured the buckling behavior for individual veins under simultaneous extension, inflation, and torsion with strong correlation between predicted critical buckling torques and experimental data (R2=0.96). We conclude that veins can buckle under torsion loading and the lumen pressure significantly affects the critical buckling torque. These results improve our understanding of vein twist behavior and help identify key factors associated in the formation of twisted veins.

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Mathematical explanation of the buckling of the vessels after twisting of the microanastomosis

Abstract: In surgical practice, with the parameters of our experimental Wistar rats model (vessel diameter, length of dissection), it is fundamental to be below 105 degrees of torsion angle for the vein microanastomosis, in order to decrease its risk of failure.

Cited by 35 publications

References 8 publications

Propeller Flaps: A Review of Indications, Technique, and Results

Propeller Flaps: A Review of Indications, Technique, and Results

Evidence to Support Controversy in Microsurgery

Twist buckling of veins under torsional loading

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