Timing of Transfer of Tubed Pedicles and Cross-flaps

Klingenström, Per; Nylén, B

doi:10.1097/00006534-196601000-00001

Cited by 12 publications

(8 citation statements)

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“…The time for these pedicled flaps to undergo safe division has ranged between 7 and 21 days. [3][4][5] These pedicled flaps again were inset into ideal tissue beds. The effect that late loss of arterial inflow will have on free flap survival has not been described clinically.…”

mentioning

confidence: 99%

Effects of Late Loss of Arterial Inflow on Free Flap Survival

Salgado¹,

Smith²,

Kim³

et al. 2002

J reconstr Microsurg

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Greater than 80 percent of free flap thromboses have been shown to occur within the first three postoperative days, warranting immediate re-exploration and restoration of adequate vessel patency. The infrequency of thromboses beyond this period is reflected in the lack of reported cases in the literature and the absence of accepted guidelines for the treatment of such delayed complications. A single study reported free flap survival in vessel thromboses only when encountered after postoperative day (POD) 7 in a pig model. Since 1990, over 800 free tissue transfers have been done at the University of Rochester. A total of ten cases of late (defined as after POD 7) arterial inflow loss were identified and examined. A retrospective chart review recorded patient demographics, site of tissue defect, free tissue transferred, major co-morbidities, preoperative XRT, timing of arterial inflow loss, nature of inflow loss, and flap survival. The mean POD of arterial inflow loss was 53 days (range: 8 to 166). The mean age of patients was 58 years. No major co-morbidities correlated with late arterial inflow loss. Loss of inflow occurred as anastomotic rupture (5), occlusion of recipient bypass graft in lower extremity cases (3), primary donor arterial thrombosis (1), and pedicle avulsion during re-exploration for seroma (1). Five flaps survived, one sustained partial necrosis, and four were completely lost. Of the five surviving flaps, three were inset into healthy recipient sites. One was utilized on a dysvascular lower extremity, and another was used in an irradiated neck defect. Of the four failed flaps, all were placed in recipient beds compromised by radiation, ischemia, or scarring. Two exemplary case reports are presented. The timing of late loss of arterial inflow does not appear to be the primary determinant of free tissue survival. The condition and quality of the recipient site plays a large role in survival of these flaps. Ischemic, irradiated, and scarred beds are inadequate in providing late flap neovascularization, compared to healthy recipient sites. When encountering late loss of arterial inflow in flaps placed on such compromised beds, the microsurgeon should not anticipate survival based on surrounding vessel ingrowth. More aggressive salvage attempts may be warranted.

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mentioning

confidence: 99%

Effects of Late Loss of Arterial Inflow on Free Flap Survival

Salgado¹,

Smith²,

Kim³

et al. 2002

J reconstr Microsurg

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“…In a series of studies, Hynes [ 16 , 17 ] reported success with extremity flaps as early as 9 days. In 1966, Klingenstrom and Nylen [ 18 ] successfully transferred tubed skin flaps from the arm to the chest with successful division in only 7 days. Notably, this experience enabled them to routinely divide clinical flaps after intervals of 7–14 days.…”

Section: Discussionmentioning

confidence: 99%

Division of a single free flap in multiple digit reconstruction

et al. 2022

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Background Single free flaps are a commonly used reconstructive method for multiple soft tissue defects in digits. We analyzed the flap size, division timing, and degree of necrosis in cases with various types of flap division.Methods We conducted a retrospective review of the medical charts of patients who had undergone single free flap reconstruction for multiple soft tissue defects across their digits from 2011 to 2020. The flap types included were the lateral arm free flap, venous forearm free flap, thenar free flap, hypothenar free flap, anterolateral thigh free flap, medial plantar free flap, and second toe pulp free flap. Flap size, anastomosed vessels, division timing, and occurrence of flap necrosis were retrospectively investigated and then analyzed using the t-test.Results In total, 75 patients were included in the analysis. The success rate of the free flaps was 97.3%. All flaps were successfully divided after at least 17 days, with a mean of 47.17 days (range, 17–243 days) for large flaps and 42.81 days (range, 20–130 days) for the medium and small flaps (P=0.596). The mean area of flap necrosis was 2.38% in the large flaps and 2.58% in the medium and small flaps (P=0.935). Severe necrosis of the divided flap developed in two patients who had undergone flap division at week 6 and week 34.Conclusions In cases where blood flow to the flap has been stable for more than 3 weeks, flap division can be safely attempted regardless of the flap size.

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“…The period of time at which it is safe to divide the primary vascular pedicle ranges from postoperative day (POD) 7 to 21, depending on the type of flap and site of reconstruction. 6,7 First signs of neovascularization between the flap and the recipient bed occur as early as POD 4, with a visible vascular channel present at POD 7. 8,9 Loss of a flap after POD 7 is rare because of the decreased reliance of the flap on the pedicle vessels.…”

Section: Introductionmentioning

confidence: 99%

Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

et al. 2018

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Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.

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Timing of Transfer of Tubed Pedicles and Cross-flaps

Cited by 12 publications

References 0 publications

Effects of Late Loss of Arterial Inflow on Free Flap Survival

Effects of Late Loss of Arterial Inflow on Free Flap Survival

Division of a single free flap in multiple digit reconstruction

Late Free Flap Failure in Head and Neck Reconstruction: A Systematic Review

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