Salvage operations of free tissue transfer following internal jugular venous thrombosis: A review of 4 cases

Miyasaka, Muneo; Ichikawa, Kota; Nakagawa, Masaki; Yamazaki, Akihisa; Taira, Hiroyuki; Imagawa, Kotaro; Tanino, Ryuzaburo

doi:10.1002/micr.20104

Cited by 31 publications

(28 citation statements)

References 24 publications

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“…Brown et al 25 and de Bree et al 26 reported up to 24% occult IJV thrombosis after neck dissection. Even if recanalization of the IJV is likely in long-term followup, 27 this complication can lead to flap loss, as described by Miyasaka et al 28 The choice of the recipient site is also challenging in the vessel-depleted neck, after prior neck dissection, or after external radiotherapy. Following multiple neck surgeries, the external jugular vein and IJV can be resected or compromised.…”

Section: Discussionmentioning

confidence: 95%

Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

et al. 2012

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Section: Discussionmentioning

confidence: 95%

Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

et al. 2012

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“…These complications often occur in the first twenty-four hours [1,5,[12][13][14]. This acute period does not allow the creation of a microvascular network, unlike what happens in chronic occlusion.…”

Section: Discussionmentioning

confidence: 99%

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

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“…Identification of thrombus should prompt opening the anastomosis and evacuation of the clot with heparinised saline irrigation or a Fogarty catheter prior to careful re anastomosis. (19) Thrombolytic agents, such as streptokinase, urokinase or tissue plasminogen activator, can be used if a thrombus is identified, particularly in the venous system. Their use has been well documented as a means to salvage vascular insufficiency and theoretically prevent irreversible ischemic reperfusion injury or no reflow phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

2016

IJASHNB

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The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in Maxillofacial reconstruction. Although associated complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction. With early recognition and prompt intervention salvage of compromised flap is possible. The purpose of this article is to emphasise the importance of keeping low threshold for re-exploration in situation of any suspected failing free flap. Pt ReportA 60 year-old male patient presented with an ulcero-proliferative mass measuring around 4cmx3.5 cm which involved the right lip mucosa and had infiltrated the underlying tissue to appear over the skin with central zone of necrosis and surrounding erythematous induration. (Fig. 1) Incisional biopsy from mucosal surface of the lesion revealed well to moderately differentiated squamous cell carcinoma. The neck was clinically N0 which similarly correlated following contrast CT scan of the neck. The surgical planning for the tumour was wide excision, SOND (Supra Omohyoid neck dissection) and reconstruction of the defect with FRAFF. Wide excision of the primary lesion was carried out along with the SOND on the affected side.The neck dissection was done with extreme care to preserve the facial vessels when dissecting level IB. Dissection of the submandibular gland was done by safely ligating the submandibular branches of the facial artery to the gland and preserving the whole artery along its course on the posterior aspect of the gland. The right lip commissure involving lateral one third of the lower lip, part of skin in the cheek along with underlying part of cheek musculature, inner buccal and labial mucosa, gingivo-buccal sulcus and gingiva along with the alveolar bone sparing the lower border of the mandible were resected. The size of the primary defect following tumour resection was 5.2x4.8x3.7 cm. The reconstruction of the surgical defect was done with FRAFF. On completion of the reconstruction the flap looked well perfused and healthy. The flap was monitored clinically at an hourly basis. By 4 th -5 th hours mild ooze from the drain port had become noticeable along with marked oedema in the flap. (Fig. 2) On the 8 th hour post operatively there was dusky appearance of the flap, along with oedema. On needle prick there was dark blood ooze from the flap and therefore the decision for re exploration was taken suspecting venous compromise. On re exploration a huge hematoma was noticed under the flap, around the anastomosis and along the IJV. The clots were delicately removed. The adjoining areas were irrigated with warm saline, and venous and arterial anastomoses were evaluated. There were no clots in the vein and normal flow through the artery was seen. Acland's "milking" test was performed. In the test the artery was occluded with a forceps immediately caudal to anastomosis and then with a second forceps artery was occl...

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Salvage operations of free tissue transfer following internal jugular venous thrombosis: A review of 4 cases

Cited by 31 publications

References 24 publications

Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

Semi‐free radial forearm flap for head and neck reconstruction in vessel‐depleted neck after radiotherapy or radical neck dissection

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

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