Surface Quantification of Injected Fluorescein as a Predictor of Flap Viability

Graham, Braun H.; Walton, Robert L.; Elings, Virgil B.; Lewis, Frank R.

doi:10.1097/00006534-198306000-00016

Cited by 66 publications

(12 citation statements)

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“…In rats where the biodegradable collagen film (2 x 5 cm) containing either PDGF-BB (360 ,ug per film) or inactive mutagenized PDGF-BB was used, films were placed between the flap of tissue and the wound bed. The skin margins were where DF is the dermatofluorometric skin reading and DFI is the dermatofluorometry index (38). The area of surviving skin was determined 3 days later (39).…”

Section: Methodsmentioning

confidence: 99%

Platelet-derived growth factor BB induces functional vascular anastomoses in vivo.

Brown

Hong

Farrell

et al. 1995

Proc. Natl. Acad. Sci. U.S.A.

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Section: Methodsmentioning

confidence: 99%

Platelet-derived growth factor BB induces functional vascular anastomoses in vivo.

Brown

Hong

Farrell

et al. 1995

Proc. Natl. Acad. Sci. U.S.A.

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“…Intradermal 133xenon clearance has also yielded good results (Palmer et al 1972, Young 1982, Young & Hopewell 1983, but this is an invasive method, the results of the injection alone increasing flow dramatically (Holloway 1980). Four noninvasive methods of measurement have been described: (1) atraumatic epicutaneous xenon clearance, a development of the intradermal technique (Englehart & Kristensen 1983); (2) photoplethysmography (Harrison et al 1981, McCaffrey et al 1980; (3) dermatofluorimetry, possibly the most reliable method ofassessment of immediate skin flap viability (Graham et al 1983, Silverman et al 1980, Wiseman et al 1982; (4) laser Doppler velocimetry (Bonner et al 1981, Holloway & Watkins 1977, Stern et al 1977, Watkins & Holloway 1982), a recently developed technique which has now become commercially available.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Skin Flap Blood Flow in the Rat Using Laser Doppler Velocimetry

Marks

1985

J R Soc Med

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Summary: Two experiments carried out on rat skin flaps are described, where microvascular flow has been measured noninvasively by a laser Doppler velocimeter. Using this technique it is possible to define the limits of an axial pattern flap in terms of microvascular flow; this was found to increase when the flap is elevated. 'Random-pattern' perfusion is defined by a fall in flow. This recovers sequentially along the flap, and at a constant rate at all sites. A differential in microvascular perfusion is thus maintained along a random-pattern flap for at least the first postoperative week. In a second experiment it is shown that there appears to be a linear relationship between the reduction in skin blood flow in a random-pattern flap and the distance from the base at which the measurements are made.It is suggested that these data support the view that the blood flow in a skin flap recovers primarily from its base rather than via peripheral neovascularization, and that this is due to vascular collaterals opening within the flap rather than to a relaxation of sympathetic tone. IntroductionThe use of pedicled skin flaps in head and neck surgery has recently declined in favour of myocutaneous flaps. The latter seem to offer flaps that are bigger, more robust and reliable and more adaptable. However, our understanding of both in terms of the physiology of their blood flow remains incomplete. In particular, there is little detailed data on what happens to microvascular flow. To date, methods available have tended to assess this indirectly, assuming it is related to the surviving length of a skin flap. More acutely, their perfusion has been assessed by dyes like fluorescein. However, these are not fully accurate visually until 24 hours (Sasaki & Pang 1980) and only give one measurement -where effective microvascular flow stops. Input/output flows in island flaps have been able to demonstrate some aspects of whole flap flow, i.e., pressure-flow functions, but reveal nothing as to how the blood is distributed (Cutting et al. 1981).This report describes how data acquired using laser Doppler velocimetry (LDV), a newly available technique, can give some insight into the physiological changes in microvascular flow in skin flaps.

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“…Our clinical experience agrees with reports that the fluorescein test overestimates the ultimate area of tissue necrosis. 4,15,16 Areas determined to be nonviable, either by lack of capillary refill or by complete nonfluorescence, are aggressively debrided at the initial operation. With aggressive initial debridement of the mastectomy skin flap, only three of the 34 patients who underwent autologous breast reconstruction by a single surgeon (J.W.M.)…”

Section: Techniquementioning

confidence: 99%

Skin Banking Closure Technique in Immediate Autologous Breast Reconstruction

Liao

Labow

May

2007

Plastic and Reconstructive Surgery

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I mmediate breast reconstruction has been facilitated by the use of skin-sparing mastectomy. 1,2 With preservation of the native breast skin envelope, various methods of autologous or prosthetic reconstruction can be performed. Numerous techniques have been described to evaluate skin flap viability, with clinical observation or fluorescein testing being the most commonly practiced methods. [3][4][5][6][7] Outcome studies of immediate breast reconstruction following skin-sparing mastectomy report mastectomy skin flap necrosis rates in the 10 to 16 percent range. 8 -14 Tobacco smoke, body mass index greater than 30, and prior breast irradiation were identified to be risk factors for mastectomy skin flap necrosis. In the series reported by Carlson et al., 97 percent of skin necrosis healed by secondary intention. 8 If skin flap necrosis results in significant full-thickness eschar, debridement and revision of the reconstruction may be required. These wound issues are especially problematic if postoperative irradiation is planned but must be delayed to allow healing of the reconstructed breast mound.We present a strategy to manage mastectomy skin flaps when the viability is unclear in immediate autologous breast reconstruction. This approach is based on the basic principle of delayed wound closure, with a planned second-look procedure, where the interval of time permits demarcation of nonviable tissue. TECHNIQUEOnce the skin-sparing mastectomy has been performed and the transverse rectus abdominis myocutaneous (TRAM) flap elevated, the mastectomy skin flaps are carefully inspected. If there is any doubt as to the viability of the mastectomy skin, a fluorescein dye test is performed as previously described. 5 Viability of the mastectomy skin flap is demonstrated by fluorescein with Wood's lamp examination of the fluorescein-perfused skin. Our clinical experience agrees with reports that the fluorescein test overestimates the ultimate area of tissue necrosis. 4,15,16 Areas determined to be nonviable, either by lack of capillary refill or by complete nonfluorescence, are aggressively debrided at the initial operation. With aggressive initial debridement of the mastectomy skin flap, only three of the 34 patients who underwent autologous breast reconstruction by a single surgeon (J.W.M.) in the years 2001 to 2005 required the skin banking technique to balance preservation of mastectomy skin with excision of ischemic skin (Table 1).In situations where the viability of significant areas of the mastectomy skin is in question, we propose the skin banking closure strategy. Here, the TRAM flap skin paddle is not fully deepithelialized. Instead, excess skin is "banked" on the TRAM flap skin paddle, which is buried under the vulnerable mastectomy skin flap and loosely closed to give the semblance of a breast mound (Fig. 1). Areas of the TRAM flap skin banked in this manner can vary. One can preserve the entire TRAM skin paddle, or only save the TRAM flap skin where the overlying mastectomy skin flap is suspected to be ischemic. T...

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Surface Quantification of Injected Fluorescein as a Predictor of Flap Viability

Cited by 66 publications

References 0 publications

Platelet-derived growth factor BB induces functional vascular anastomoses in vivo.

Platelet-derived growth factor BB induces functional vascular anastomoses in vivo.

Quantitative Analysis of Skin Flap Blood Flow in the Rat Using Laser Doppler Velocimetry

Skin Banking Closure Technique in Immediate Autologous Breast Reconstruction

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