Survival of a free flap after arterial disconnection at six days

Kissun, Dean; Shaw, Richard; Vaughan, E.D.

doi:10.1016/s0266-4356(03)00265-1

Cited by 17 publications

(8 citation statements)

References 6 publications

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“…Although these findings support the importance of an intact vascular pedicle for permanent flap survival, especially in irradiated recipient sites, other reports document early autonomization which became evident after division of the pedicle during the first days after surgery 11, 12, 17–20. According to these well‐documented clinical cases, neovascularization seems to be capable of sustaining the flap from about 5 days post surgery.…”

Section: Discussionmentioning

confidence: 69%

Autonomization of free flaps in the oral cavity: A prospective clinical study

et al. 2012

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Controversy exists over how long a free flap is dependent on its pedicle and if neovascularization is different between flap types, recipient sites, and irradiated and nonirradiated patients. An understanding of the timing of this process should optimize the safety of secondary procedures involving the flap. In a prospective clinical study, hemoglobin oxygenation and capillary flow were measured in 50 flaps (25 forearm flaps, 15 osteocutaneous fibula flaps, and 10 anterolateral thigh flaps) 4 and 12 weeks postoperatively. The flaps were located at the floor of the mouth, cheek, or tongue (n = 39) or at the hard or soft palate (n = 11). Measurements were carried out using the O2C monitoring system under temporary digital occlusion of the pedicle. After 4 weeks, 17 free flaps were found to be autonomized indicated by the O2C measurements comparing both values before and after digital compression of the vascular pedicle. After 12 weeks, 41 patients had completion of free flap autonomization, as indicated by the HbO(2) and CF before and after pedicle compression. The location of free flap in the lower jaw (P < 0.0001 after 4 weeks, P = 0.013 after 12 weeks), fasciocutaneous radial forearm flaps after 4 weeks (P < 0.0001), and not irradiated recipient site after 4 weeks (P = 0.014) were found to be positive factors significantly influencing autonomization. In conclusion, free flap autonomization depends on several variables which should be considered before further surgery after free flap reconstruction as the transferred tissue can be still dependent on its pedicle.

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Section: Discussionmentioning

confidence: 69%

Autonomization of free flaps in the oral cavity: A prospective clinical study

et al. 2012

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“…Twenty‐two articles described 32 flaps that survived and five articles described 11 flaps that failed after delayed vascular compromise without surgical intervention (Table ). Among the reported demographic information in both cohorts, most baseline characteristics of patients were not significantly different (Table ).…”

Section: Resultsmentioning

confidence: 99%

Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: A review of the literature

Yoon

Jones

2016

Microsurgery

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This analysis suggests that free flaps compromised by vascular thrombosis or pedicle ligation may survive with only conservative therapy when the event occurs after a minimal critical time period. Flap survival is more probable when arterial occlusion or pedicle ligation occurs after postoperative day 12, but this minimal critical period may be as low as 6 days for arterial occlusion. © 2016 Wiley Periodicals, Inc. Microsurgery 36:604-612, 2016.

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“…13,14 Similarly, some clinical case reports have claimed complete survival of a free flap after loss of the arterial pedicle from 6 to 9 days postoperatively. [15][16][17] Although this may partially explain the success of early endovascular or nonsurgical conservative treatments in the reported pseudoaneurysms, it should not be viewed as a standard of care.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Pseudoaneurysm Following Reverse Radial Forearm Free Tissue Transfer

Baynosa

Echo²,

Hovsepian

et al. 2007

J reconstr Microsurg

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The appearance of a pseudoaneurysm in a free flap is an extremely rare complication in microsurgery. Yet, although uncommon, this occurrence still poses a dilemma as to the most effective mode of treatment. Treatment modalities consist of surgical exploration, embolization, and endovascular stenting. We present a case of arterial pedicle pseudoaneurysm following free tissue transfer of a radial forearm flap for a cranial defect. We describe our successful operative treatment of the pseudoaneurysm as well as review the literature regarding the applicability of the described treatments. We conclude that a critical evaluation of factors including the timing of arterial inflow loss, the necessity of the pedicle, the condition and quality of the recipient site, and the possibility of neovascularization can assist in determining the proper intervention and maximizing success.

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Survival of a free flap after arterial disconnection at six days

Cited by 17 publications

References 6 publications

Autonomization of free flaps in the oral cavity: A prospective clinical study

Autonomization of free flaps in the oral cavity: A prospective clinical study

Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: A review of the literature

Iatrogenic Pseudoaneurysm Following Reverse Radial Forearm Free Tissue Transfer

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