Patterns of Vascular Anastomoses Vs. Success of Free Groin Flap Transfers

Goodstein, Wallace A.; Buncke, Harry J.

doi:10.1097/00006534-197907000-00007

Cited by 50 publications

(15 citation statements)

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“…1,3,5,6 It has been well established in the literature that early detection followed by early reexploration of vascular compromised flaps results in improved salvage rates. 1,3,5,7,8 Compared with arterial ischemia alone, the pathophysiology involved in venous thrombosis is associated with a greater degree of irreversible damage to the microvascular system of the flap 9–11 and thus results in lower salvage rates. 1,5 Early detection and surgical reexploration after venous thrombosis is imperative if a flap is to be salvaged.…”

mentioning

confidence: 99%

Early Detection of Complete Vascular Occlusion in a Pedicle Flap Model Using Quantitation Spectral Imaging

Pharaon

Scholz

Bogdanoff

et al. 2010

Plastic and Reconstructive Surgery

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Background Vascular occlusion after tissue transfer is a devastating complication that can lead to complete flap loss. Spatial frequency domain imaging is a new, noncontact, noninvasive, wide-field imaging technology capable of quantifying oxygenated and deoxygenated hemoglobin levels, total hemoglobin, and tissue saturation. Methods Pedicled fasciocutaneous flaps on Wistar rats (400 to 500 g) were created and underwent continuous imaging using spatial frequency domain imaging before and after selective vascular occlusion. Three flap groups (control, selective arterial occlusion, and selective venous occlusion) and a fourth group composed of native skin between the flaps were measured. Results There were no statistically significant differences between the control flap group and the experimental flap groups before selective vascular occlusion: oxyhemoglobin (p = 0.2017), deoxyhemoglobin (p = 0.3145), total hemoglobin (p = 0.2718), and tissue saturation,(p = 0.0777). In the selective arterial occlusion flap group, percentage change in total hemoglobin was statistically different from that of the control flap group (p = 0.0218). The remaining parameters were not statistically different from those of the control flap: percentage change in oxyhemoglobin (p = 0.0888), percentage change in deoxyhemoglobin (p = 0.5198), and percentage change in tissue saturation (p = 0.4220). The selective venous occlusion flap group demonstrated changes statistically different compared with the control flap group: percentage change in oxyhemoglobin (p = 0.0029) and deoxyhemoglobin, total hemoglobin, and tissue saturation (p < 0.0001). Conclusions Spatial frequency domain imaging provides two-dimensional, spatially resolved maps of tissue oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue saturation. Results presented here indicate that this can be used to quantify and detect physiologic changes that occur after arterial and venous occlusion in a rodent tissue transfer flap model. This portable, noncontact, noninvasive device may have a high clinical applicability in monitoring postoperative patients.

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confidence: 99%

Early Detection of Complete Vascular Occlusion in a Pedicle Flap Model Using Quantitation Spectral Imaging

Pharaon

Scholz

Bogdanoff

et al. 2010

Plastic and Reconstructive Surgery

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“…3,[9][10][11][12][13] The arterial microanastomosis in our study was patent with all our patients. With two of them (6.06%) angiographic signs of arterial microvascular stenosis were registered.…”

Section: Discussionmentioning

confidence: 94%

“…wiley.com. ]Concentrations of the radiopharmacs in the tissue of the transferred free flaps were 2.3 times higher than in the surrounding area of the recipient region according to radionuclear arteriography (Figs [13][14][15][16][17][18]…”

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confidence: 99%

Some biological characteristics of transferred free flaps

Kozarski

2007

Microsurgery

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At the Clinic for plastic surgery and burns of the MMA, we examined 33 patients with transferred 5 cutaneous, 18 myocutaneous, and 10 osteocutaneous free flaps out of which 10 were done on foot, 13 on the lower leg, and 10 on the face. We analyzed the blood circulation (patency of arterial microanastomosis and perfusion) of transferred free flaps, recovery of sensitivity, functioning of the sebaceous and sweat glands as well as histomorphologic changes in the skin of the transferred free flaps during the period of 6 up to 36 months after the free flap transfer and compared with the same characteristics of the skin and tissue of the surrounding area of the recipient region.

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“…2 Therefore, strict evaluation of flap perfusion is essential to prevent, recognize, and treat complications in the postoperative period of the axial flaps. 3 Early identification of flap failure is a precondition of flap salvage and therefore important for flap prognosis. Although several techniques of axial-flap monitoring are available, there is still no single reliable noninvasive technique for early recognition of flap failure.…”

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confidence: 99%

A Method for Flap Monitoring Based on Bioelectrical-Resistance Analysis

Misirlioğlu¹,

Karaca²,

Avcı³

et al. 2011

Journal of Craniofacial Surgery

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Axial pattern flaps are characterized by a single vascular pedicle that supplies the whole flap and carry the danger of flap loss. For this reason, monitoring and early identification of vascular perfusion is important for flap prognosis. The most commonly used method for flap monitoring is clinical assessment, but it has certain limitations. The bioelectrical properties of tissues can be affected by ischemic conditions, and a preliminary study showed that the bioelectrical resistance of blood was decreased under thrombotic conditions. In this controlled study, the resistance values of the axial flaps were calculated during thrombosis. A total of 28 rats were randomly divided into a control group (n = 14) and an experimental group (n = 14). Axial flaps were elevated based on the inferior epigastric pedicle. For the ischemic group, microvascular clamps were placed in the ischemic group to produce artificial thrombosis from day 1 of the experiment. Bioelectrical resistance was measured every 30 minutes for the first 6 hours and then daily after that. The resistance values from the ischemic group decreased progressively, and 150 minutes after the clamping, the difference became statistically significant (P < 0.05). The results showed that the assessment of flap resistance is a valuable tool and may allow early recognition of a compromise in the vascular system before clinical signs become obvious.

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Patterns of Vascular Anastomoses Vs. Success of Free Groin Flap Transfers

Cited by 50 publications

References 0 publications

Early Detection of Complete Vascular Occlusion in a Pedicle Flap Model Using Quantitation Spectral Imaging

Early Detection of Complete Vascular Occlusion in a Pedicle Flap Model Using Quantitation Spectral Imaging

Some biological characteristics of transferred free flaps

A Method for Flap Monitoring Based on Bioelectrical-Resistance Analysis

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