Perfusion of muscle flaps independent of the anatomical vascular pedicle: Pedicle autonomy

Bradshaw, Kimberley; Wagels, Michael

doi:10.1016/j.bjps.2017.05.049

Cited by 13 publications

(8 citation statements)

References 28 publications

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“…In this study, they demonstrated neovascularization on the level of micro‐circulation, initiated 3 days after surgery with a completed major flap autonomization after 10 days. Similar results could be demonstrated by Bradshaw et al, who analysed the outcome of muscle flaps after pedicle ligation in the rat animal model . They found pedicle autonomy initiating at 21 days even in muscle flaps.…”

Section: Discussionsupporting

confidence: 85%

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Wound closure by means of free flap and arteriovenous loop: Development of flap autonomy in the long‐term follow‐up

Rother

Müller‐Mohnssen

Lang

et al. 2019

International Wound Journal

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Free flaps in combination with arterial reconstruction by means of arteriovenous loops or bypass have, meanwhile, been established as a therapeutic option in defect reconstruction for areas without recipient vessels. Our aim was to analyse the long-term performance, flap autonomy, and the flap perfusion. Patients receiving this combined reconstruction at a single-centre institution were included. During follow-up examination, the patency of arterial reconstruction was investigated by duplex ultrasound. Flap micro-circulation was assessed by laser Doppler flowmetry and white light tissue spectrometry (O2C) as well as by indocyanine green fluorescence angiography. Twentythree patients could be clinically followed up. Duplex ultrasound showed, in four cases, arterial pedicle occlusion in spite of vital flap. Comparison of the O2C perfusion parameters between flaps with occluded pedicles and those with intact inflow showed no significant difference (parameters sO2: P = .82; Flow: P = .31). Similar results were obtained by fluorescence angiography; no significant difference could be detected between both groups (parameters Ingress P = .13; Ingressrate P = .54). Combined vascular reconstruction with free tissue transfer is associated with a good long-term outcome and wound closure. Even after flap transplantation to areas with critical tissue perfusion, the flap can develop autonomy and thus survive after pedicle occlusion.

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Section: Discussionsupporting

confidence: 85%

“…This phenomenon has already been described by Theile et al for cutaneous flaps. Bradshaw et al found similar results for the muscle flaps, as they pointed out the relevance of the skin at the point of flap inset …”

Section: Discussionmentioning

confidence: 69%

Wound closure by means of free flap and arteriovenous loop: Development of flap autonomy in the long‐term follow‐up

Rother

Müller‐Mohnssen

Lang

et al. 2019

International Wound Journal

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“…[ 3 ] Enhancement of angiogenesis in axially vascularized tissues has been performed through an additional extrinsic vascular pathway, which allows for transplantation of the entire construct by means of the arteriovenous loop pedicle. [ 4 ] Furthermore, in another approach, addition of angiogenic factors may also facilitate vascularization of the engineered tissue grafts. For instance, the use of genetically modified myoblasts expressing vascular endothelial growth factor has been investigated to enhance neovascularization and tissue mass of engineered muscle in vivo .…”

Section: Introductionmentioning

confidence: 99%

In vitro Flow Perfusion Maintaining Long-term Viability of the Rat Groin Fat Flap

Nie

Qin

et al. 2018

Chinese Medical Journal

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Background:Large-scale muscle tissue engineering remains a major challenge. An axial vascular pedicle and perfusion bioreactor are necessary for the development and maintenance of large-scale engineered muscle to ensure circulation within the construct. We aimed to develop a novel experimental model of a large-scale engineered muscle flap from an existing rat groin fat flap.Methods:A fat flap based on the superficial inferior epigastric vascular pedicle was excised from rats and placed into a perfusion bioreactor. The flaps were kept in the bioreactor for up to 7 weeks, and transdifferentiation of adipose to muscle tissue could have taken place. This system enabled myogenic-differentiation medium flow through the bioreactor at constant pH and oxygen concentration. Assessment of viability was performed by an immunofluorescence assay, histological staining, a calcein-based live/dead test, and through determination of RNA quantity and quality after 1, 3, 5, and 7 weeks.Results:Immunofluorescence staining showed that smooth muscle around vessels was still intact without signs of necrosis or atrophy. The visual assessment of viability by the calcein-based live/dead test revealed viability of the rat adipose tissue preserved in the bioreactor system with permanent perfusion. RNA samples from different experimental conditions were quantified by spectrophotometry, and intact bands of 18S and 28S rRNA were detected by gel electrophoresis, indicating that degradation of RNA was minimal.Conclusions:Flow perfusion maintains the long-term viability of a rat groin engineered muscle flap in vitro, and a large-scale vascularized muscle could be engineered in a perfusion bioreactor.

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Section: Discussionmentioning

confidence: 99%

“…The critical interval for free flap autonomization of the vascular pedicle differs between fasciocutaneous and muscle flaps. Experimental research in rats has shown a reliable fasciocutaneous autonomization as early as 5-10 days following reconstruction, whereby muscle flaps autonomy is reliable at 21 days (Bradshaw & Wagels, 2017;Mücke et al, 2011). Accordingly, Yoon and Jones demonstrated in a FIGURE 2 Clinical aspect of the parascapular (PSC) flap on the right lower leg of the patient: A, on hospital admission in the 7th week postoperative after PSC flap reconstruction, the flap was bluish and mottled in the proximal part; B, on the day of hospital discharge (9th week postoperative) the bluish color had disappeared with remaining signs of epitheliolysis; and C, in the follow up examination 11 weeks after the reconstructive procedure, the soft tissue had recovered completely and all zones of the flap were viable FIGURE 3 Near-infrared imaging of the parascapular (PSC) flap immediately following indocyanin green injection: A, on the day of hospital admission, 7 weeks after the reconstructive procedure the proximal part of the PSC flap showed signs of hypoperfusion (white arrow) and B, in the follow up examination 4 weeks after the intervention (11 weeks after the microsurgical procedure) the flap was well perfused in all zones systemic analysis an earlier flap survival of fasciocutaneous flaps when compared to muscle flaps after free flap pedicle obstruction (Yoon & Jones, 2015).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of perfusion by near‐infrared fluorescence imaging in late pedicle obstruction of a parascapular flap to the lower extremity: A case report

et al. 2018

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Late free flap failures due to pedicle obstruction are rare adverse events. The purpose of this report is to present a case in which the near-infrared indocyanine green video angiography (ICG-NIR-VA) was used to evaluate the perfusion in a compromised fasciocutaneous flap in the late postoperative period. A 55-year-old male patient, who initially suffered from an open tibial fracture, developed concurrent osteomyelitis with fistulae of the proximal tibia requiring excision. Reconstruction was achieved using a parascapular flap of 25 × 8 cm, anastomosed to an arterio-venous (AV) Loop in the adductor canal. On the 2nd postoperative day the patient developed a thrombosis of the AV-Loop. After thrombectomy, the postoperative course was uneventful. Seven weeks postoperatively the patient presented with a mottled, partially bluish and cold flap. Anticoagulation prophylaxis was stopped 2 days earlier. Angiography confirmed a thrombus in the arterial pedicle leading to flap ischemia. Near infrared guided fluorescence imaging revealed a delayed recapillarization of the proximal part of the flap closest to the vascular pedicle, albeit flap overall perfusion remained intact. Thus, no surgical intervention was undertaken. However, anticoagulation and prostaglandin therapy was initiated and the flap was salvaged. Genetic analysis uncovered a polymorphism in the prothrombin genes. The flap remained viable and without further complications until the last follow-up visit at 36 weeks after microsurgical reconstruction. The patient was fully mobilized with complete return to function. Near-infrared guided fluorescence imaging may be a viable tool for the assessment of late fasciocutaneous free flap complications and guide the decision-making process.

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Perfusion of muscle flaps independent of the anatomical vascular pedicle: Pedicle autonomy

Cited by 13 publications

References 28 publications

Wound closure by means of free flap and arteriovenous loop: Development of flap autonomy in the long‐term follow‐up

Wound closure by means of free flap and arteriovenous loop: Development of flap autonomy in the long‐term follow‐up

In vitro Flow Perfusion Maintaining Long-term Viability of the Rat Groin Fat Flap

Evaluation of perfusion by near‐infrared fluorescence imaging in late pedicle obstruction of a parascapular flap to the lower extremity: A case report

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