Secondary Delayed Venous Ischemia in Flow-Through Radial Forearm Free Flaps: A Novel Treatment Technique

Bacakoğlu, A Kadir; Özkan, Mustafa; Muratlı, Kıvanç; Ekin, Atalay

doi:10.1097/00006534-200208000-00029

Cited by 7 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Arterial grafts and flow-through free flaps, especially in cases of severe trauma, are safe alternatives to vein grafts in the forearm. 24 Prosthetic conduits, however, were not found to be useful. 16 It is hoped that future advances in molecular biology and tissue engineering will enable development of appropriate biological conduits.…”

Section: Forearm Arterial Vein Graftingmentioning

confidence: 96%

Forearm Arterial Vein Grafting: Problems and Alternative Solutions

et al. 2003

View full text Add to dashboard Cite

We aimed to evaluate patency rates following forearm arterial reconstruction and suggest improvements. Thirty-two vein grafted reconstructions (using saphenous and dorsal hand veins) were evaluated for patency and development of symptoms using clinical examination, Colour-Doppler Sonography and angiography. Overall patency was 59%, with no significant difference between saphenous and dorsal hand veins. Stasis, turbulence, decrease in blood velocity, change in flow pattern, stenosis in the anastomotic area or increase in compliance was detected in 10 patent grafts, but was not associated with symptoms. Six out of 13 non-patent grafted patients had severe or troublesome symptoms associated with accompanying nerve regeneration. To improve patency, careful microsurgical techniques, 'fit vein' and valveless grafts should be used. Dorsal hand veins are most appropriate for short defects. Patency should be evaluated soon after reconstruction.

show abstract

Section: Forearm Arterial Vein Graftingmentioning

confidence: 96%

Forearm Arterial Vein Grafting: Problems and Alternative Solutions

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Simultaneous transfer of vascularized bone graft or osteocutaneous flap together with forearm flap Hallock 12 Midfoot/Lower extremity peripheral vascular disease 1 Partial failure of radial forearm flap salvaged by using surviving portion as ' 'bridge' ' flap for revascularizing second free flap (gracilis) Kasten et al 13 Upper extremity trauma 1 Burt et al 62 Mid face trauma 1 Radial forearm flaps used in flow-through manner between gracilis flaps on each side and respective facial vasculature Tseng et al 8 Foot/Lower extremity trauma 1 Lateral antebrachial cutaneous n. Anastomosed to deep peroneal n. As sensate flap Libermanis et al 17 Hand trauma 2 Distally based, retrograde, radial forearm flaps for finger revascularization and soft tissue coverage Bacakoglu et al 1 Upper extremity trauma 2 Described treating delayed venous ischemia in flow-through flap using arteriovenous anastomosis Coban et al 10 Hand infection 1 Dorsal hand injury secondary to anthrax exposure Chun and Marin 9 Forefoot/Lower extremity peripheral vascular disease 2 Radial artery flow-through flap used as vascular conduit that provides venous outflow and acts as a functional modulated arteriovenous fistula Muneuchi et al 11 Lower extremity trauma 1 Radial forearm FTF used to restore soft tissue loss after replantation of leg Teodorescu et al 6 Lower extremity peripheral vascular disease 10 Composite femoral-tibial bypass graft constructed by sewing radial forearm graft to either greater saphenous vein or polytetrafluoroethylene graft Ulnar forearm Lovie et al 22 Defect in oral cavity, lower extremity, maxilla 11 Libermanis et al 17 Hand trauma 1 One-stage recon of two rays with soft-tissue defect and associated segmental defect of metacarpals and flexor tendons, nerves and arteries Posterior interosseous Shibata et al 24 Hand trauma 3…”

Section: Number Of Cases Commentsmentioning

confidence: 99%

“…There is evidence to suggest that when long vein grafts are used, reverse flow within vein grafts and arteries can cause turbulent flow, stasis, and thrombosis. 1 Alternatively, prosthetic vascular grafts, which are often used when vein grafts are not available, have been shown to have significantly lower patency and limb salvage rates, as well as a higher incidence of infectious complications. 2,3 Therefore, in complex extremity injuries, a flow-through flap in which a native vascular conduit is used for revascularization is an important alternative to consider.…”

mentioning

confidence: 99%

Flow-through flaps: A review of current knowledge and a novel classification system

et al. 2006

View full text Add to dashboard Cite

Flaps have long been recognized as an essential tool for soft-tissue reconstruction. Flaps range in complexity from local to free and perforator flaps and can include a variety of composite tissues. The concept of a flow-through flap, in which both the proximal and the distal ends of the vascular pedicle of a free flap are anastamosed to provide blood flow to distal tissues, was first described by Soutar et al. in 1983. An uninterrupted arterial flow was established by Soutar et al. between the external carotid and distal facial artery via a radial forearm flap for head and neck reconstruction (Soutar et al., Br J Plast Surg 1983;36:1-8). Shortly thereafter, Foucher et al. were the first to report the reconstruction of an extremity with a simultaneous vascular defect by utilizing a radial forearm flow-through flap (Foucher et al., Br J Plast Surg 1984;37:139-148). The utility of the flow-through flap is now well established, and its indications for use continue to grow. The principle advantage of this flap is that it provides the opportunity for a single stage composite reconstruction of both soft tissue and vascular defects, making it particularly useful in the reconstruction of ischemic extremities and defects from oncologic ablations. Improvements in microsurgical equipment and techniques are making early difficulties with these flaps irrelevant, giving plastic surgeons opportunities to become more creative in the choices and uses of flow-through flaps. The literature consists mostly of case reports and series. The nomenclature used to describe the types of flow-through flaps is confusing and inconsistent. The purpose of this article is to provide an organized review of flow-through flaps and to classify these flaps based on their inflow, outflow, and the nature of their vascular conduit. Additionally, we have included a discussion on the physiology of these flaps, reviewed the current literature, and summarized the various types of flow-through flaps in a reference guide that can aid in flap selection.

show abstract

“…he clinical application of flow-through anastomosis has been reported in various studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The main purpose of reports on the early stage of flow-through anastomosis application [1][2][3][4][5][6][7] was to preserve distal perfusion of recipient vessels. Most of the cases in these early reports involved extremity trauma, in which distal ischemia and tissue defects could be simultaneously reconstructed using free flaps by flow-through arterial anastomosis.…”

mentioning

confidence: 99%

A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study

Kagaya

Arikawa

Akazawa

et al. 2021

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Background:The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and endto-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined. Methods: Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state).Results: In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 ± 14.1 ml/ minute versus 6.0 ± 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 ± 3.7 versus 13.6 ± 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values. Conclusion:In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements.

show abstract

Secondary Delayed Venous Ischemia in Flow-Through Radial Forearm Free Flaps: A Novel Treatment Technique

Cited by 7 publications

References 10 publications

Forearm Arterial Vein Grafting: Problems and Alternative Solutions

Forearm Arterial Vein Grafting: Problems and Alternative Solutions

Flow-through flaps: A review of current knowledge and a novel classification system

A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study

Contact Info

Product

Resources

About