The Effect of an Implantable Doppler Probe on the Salvage of Microvascular Tissue Transplants

Kind, Gabriel M.; Buntic, Rudolf F.; Buncke, Gregory M.; Cooper, Timothy M.; Siko, Peter P.; Buncke, Harry J.; Swartz, William M.

doi:10.1097/00006534-199804010-00017

Cited by 21 publications

(38 citation statements)

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“…Most research groups have been interested in evaluating techniques that assess blood flow [1,2,3,4,5,6,7,8] and the factors that are involved when ischemia/ reperfusion injuries develop [9,10,11,12,13,14,15,16,17,18]. We have focussed on finding a role for microdialysis in this context.…”

Section: Introductionmentioning

confidence: 99%

Comparing metabolism during ischemia and reperfusion in free flaps of different tissue composition

et al. 2002

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Using microdialysis, the interstitial kinetics of glucose, lactate, pyruvate and glycerol were studied during ischemia and reperfusion in 39 human free flaps of different tissue compositions (skin, muscle and adipose tissue). The concentration of the substances were determined repeatedly during ischemia and reperfusion, and laser doppler flowmetry was used to document revascularization. Microdialysis catheters were placed in flap tissue and similar non-operated control tissue. Increased levels of lactate and glycerol and decreased glucose and pyruvate concentrations were observed in the flaps during ischemia. We were able to document different metabolic patterns because the various flaps consisted of different tissue. Variables involved in glycolysis (glucose, lactate and pyruvate) changed faster in muscle than in other flap tissues, whereas the glycerol increase was most evident in flaps that were composed predominantly of adipose tissue. During reperfusion all metabolites returned towards pre-ischemic levels within a few hours. However, pyruvate and glucose levels sometimes remained elevated over long periods (up to 24 h of reperfusion) in muscular flaps, possibly due to hypermetabolism, increased capillary flow or other unknown factors. It can be concluded that the dynamics of metabolism vary between flaps of different tissue compositions. This can be visualized during ischemia and reperfusion by using microdialysis.

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Section: Introductionmentioning

confidence: 99%

Comparing metabolism during ischemia and reperfusion in free flaps of different tissue composition

et al. 2002

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“…The ultrasonic Doppler is simple and noninvasive; however, the relevant signals are difficult to differentiate from those of nearby arteries and veins or from neck movements. Although good accuracy has been reported with an implantable Doppler probe for other areas of free flap reconstruction [17][18][19][20], its use in head and neck reconstruction may be limited because of unfavourable geometry, difficult positioning, interference with other vessels, and easy displacement caused by neck movement or coughing. Dissection of the jejunal flap into two parts and external monitoring were first described by Katsaros et al [15].…”

Section: Discussionmentioning

confidence: 99%

“…Using a laryngeal fiberscope, creating a surgical window [14], or externalising an indicator segment [15,16] allows for direct observation of peristalsis and mucosal or serosal colour. Indirect monitoring methods include the use of implantable and handheld Dopplers [17][18][19][20], intramucosal PCO 2 measurement [21] and tonometric pHi monitoring [22]. However, these methods are subject to various technical or validity problems.…”

Section: Introductionmentioning

confidence: 99%

A “watch window” technique for monitoring buried free jejunum flaps during circumferential pharyngolaryngectomy reconstruction

Zhang

Liu

et al. 2011

Eur Arch Otorhinolaryngol

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The free jejunum flap approach is the optimal option for circumferential pharyngolaryngectomy reconstruction. In this study, we designed a "watch window" for monitoring buried free jejunum flaps, thereby allowing us to assess graft viability. From 2007 to 2011, 14 patients with hypopharyngeal cancer underwent circumferential pharyngolaryngectomy that was reconstructed using a free jejunum flap at the Sun Yat-sen University Cancer Centre. During the closing of the neck incision, a "watch window" was designed for postoperative monitoring. Two patients experienced thrombosis of the pedicle. One was detected early and successfully rescued by removal of the thrombosis, the other one managed with a second free jejunum flap. The success rate of the buried flaps was 92.9%. No pharyngocutaneous fistulas or strictures occurred. All patients eventually resumed oral feeding and swallowing. The "watch window" technique for monitoring buried free jejunum flaps is simple, reliable and useful for finding vascular problems. Level of evidence Case series.

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“…Various techniques have been described for free flap monitoring, including visual observation of the flap color, capillary refilling, and bleeding by needle stick; ultrasonic Doppler, color Doppler, laser Doppler flowmetry, surface thermometry, pulse oximetry, and implantable Doppler monitoring. The technique for free flap monitoring is subject to personal preference [20][21][22]. Recent technological advances have made it possible to perform anastomoses between the vessels of the flap pedicle and the recipient vessels in a shorter time by using microvascular anastomotic coupler devices [23].…”

Section: Microvascular Free Tissue Transfer (Free Flaps)mentioning

confidence: 99%

Surgical reconstruction in patients with cancer of the head and neck

Vural

2004

Curr Oncol Rep

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Reconstructive surgical techniques have greatly changed the treatment approach for patients with cancer of the head and neck. These techniques provide head and neck surgeons the flexibility of performing tumor resection without concerns about the repair of the final defect and significantly increase the quality of life in patients who have undergone ablative surgery by providing better cosmetic and functional outcome after cancer resection. Reconstruction of the defects after ablative surgery for head and neck cancer includes various options, and each option has its own advantages and disadvantages. Techniques for head and neck reconstruction are summarized in this article along with recent advances in their application.

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The Effect of an Implantable Doppler Probe on the Salvage of Microvascular Tissue Transplants

Cited by 21 publications

References 0 publications

Comparing metabolism during ischemia and reperfusion in free flaps of different tissue composition

Comparing metabolism during ischemia and reperfusion in free flaps of different tissue composition

A “watch window” technique for monitoring buried free jejunum flaps during circumferential pharyngolaryngectomy reconstruction

Surgical reconstruction in patients with cancer of the head and neck

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