The Effect of Pedicle Artery Vasospasm on Microhemodynamics in Anatomically Perfused and Extended Skin Flap Tissue

Wettstein, Reto; Wessendorf, Robert; Sckell, Axel; Leunig, Michael; Banič, Andrej; Erni, Dominique

doi:10.1097/00000637-200045020-00010

Cited by 5 publications

(4 citation statements)

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“…skin flaps and concluded that the development of ischemic necrosis in extended flap portions may be promoted by prolonged vasospasm, which is well tolerated in the anatomically perfused tissue because of its high compensatory capacity for regulatory mechanisms. 30 In contrast to the present study, they produced a severe arterial vasospasm, resulting in a decrease down to 7% of its original diameter. Although we did not create any intended vasospasm by clamping the vessels, their evaluation of A1 and A3 arterioles revealed similar results to our data regarding the AVD and BCV.…”

Section: Discussioncontrasting

confidence: 99%

Flap Microcirculation: Effects of Tissue Manipulation and In Situ Preparation during Soft Tissue Harvest

Scholz

Evans

2008

J reconstr Microsurg

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Microcirculatory disturbances during tissue transfer can lead to tissue damage and decreased flap survival. In this pilot study, we evaluated the influence of pedicle preparation and flap manipulation on the microcirculation of free flaps during harvest. Twenty-eight Sprague Dawley rats were divided into two groups. In group A, microcirculation was investigated before and after in situ preparation of an inferior epigastric flap with dissection of all vascular structures using the orthogonal polarization spectral imaging technique. In group B, the second investigation of microcirculation was performed 20 minutes after skin incision without further manipulations. Group A demonstrated a considerable decline in blood cell velocity, arterial vessel diameter, venous vessel diameter (VVD), and functional capillary density (FCD), whereas group B showed stable values. There was a significant difference between groups for VVD and FCD. Flap manipulation with dissection of the pedicle leads to microcirculatory disturbances. We assume that these microcirculatory disturbances may result in prolonged duration of flap ischemia contributing to an increased failure rate after free tissue transfer.

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Section: Discussioncontrasting

confidence: 99%

Flap Microcirculation: Effects of Tissue Manipulation and In Situ Preparation during Soft Tissue Harvest

Scholz

Evans

2008

J reconstr Microsurg

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Section: Discussionmentioning

confidence: 99%

“…23 This is probably due to the lack of capacity of flap tissue for implementing compensatory regulatory mechanisms after an ischemic insult. 23 Furthermore, subclinical vasospasm can lead to early clot formation at the anastomosis. 4 In our series, one case of subclinical transient vasospasm of the donor artery in a latissimus muscle flap showed in the ICGvideoangiography by a significant delay in the inflow of dye when compared with the surrounding skin (Fig.…”

Section: Discussionmentioning

confidence: 99%

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

et al. 2002

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In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome.

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“…[4][5][6] Vasoconstriction in microvascular surgery is believed to be one of the causes of intraoperative or postoperative ischemia, especially after 24 to 48 hours. [7][8][9] It is induced by various factors, including the myogenic response resulting from surgical trauma such as the dissection, clamping, and anastomosis of pedicle vessels. [10][11][12] Vasoconstrictors may also be released from sympathetic nerves (norepinephrine), platelets (thromboxane A2), or endothelial cells (endothelin-1).…”

mentioning

confidence: 99%

Efficacy of Ethyl Nitrite in Reversing Surgical Vasospasm

Baccarani¹,

Yasui²,

Olbrich³

et al. 2007

J reconstr Microsurg

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Vasospasm leading to thrombosis is a major cause of free flap failure. Flap blood flow may improve by application of vasodilating agents to the pedicle. The purpose of this study is to evaluate the effect of a novel S-nitrosylating agent, O-ethyl nitrite, on flap blood flow and pedicle vessels diameter in a rat model, after induction of vasospasm. Two hours after surgery, the arterial diameter was significantly (P < .05) dilated by treatment with O-ethyl nitrite, lidocaine, or lidocaine + O-ethyl nitrite. None of these treatments had a statistically significant effect on blood flow or venous diameter. Twenty-four hours following surgery, both O-ethyl nitrite- and lidocaine-treated groups had larger arteries than the control group (P < .05). The O-ethyl nitrite-treated animals also had significantly (P < .05) elevated blood flow compared with control animals, but lidocaine-treated animals did not demonstrate any improved flow at 24 hours. O-Ethyl nitrite may become clinically useful in microvascular surgery procedures.

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The Effect of Pedicle Artery Vasospasm on Microhemodynamics in Anatomically Perfused and Extended Skin Flap Tissue

Cited by 5 publications

References 0 publications

Flap Microcirculation: Effects of Tissue Manipulation and In Situ Preparation during Soft Tissue Harvest

Flap Microcirculation: Effects of Tissue Manipulation and In Situ Preparation during Soft Tissue Harvest

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

Efficacy of Ethyl Nitrite in Reversing Surgical Vasospasm

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