Two-stage Reconstruction of the Scalp with Facial AV Loop

Clegg, Devin J; Winstead, Michael

doi:10.1097/gox.0000000000002941

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…However, literature comparing outcomes based on donor vein is lacking. Another option when both venous and arterial options are scarce is to employ an AV loop which, in previous studies, has shown a free flap success rate ranging between 80% and 100% 4,13,18–20 …”

Section: Discussionmentioning

confidence: 99%

“…Another option when both venous and arterial options are scarce is to employ an AV loop which, in previous studies, has shown a free flap success rate ranging between 80% and 100%. 4,13,[18][19][20] The use of AV grafts to facilitate free tissue applications in head and neck reconstruction has previously been described in the literature. 1,4,5,[9][10][11]17 Creation of an autologous AV loop graft can be the precursor for immediate simultaneous vein grafting or a delayed maturation yielding a true arteriovenous fistula.…”

Section: Discussionmentioning

confidence: 99%

“…The use of vein grafts, often saphenous or cephalic, have been previously described in the literature to facilitate microvascular reconstruction by bridging gaps between the donor and recipient vessels as well as creating alternate vascular conduit from larger bore vessels. 1,3,4,[10][11][12][13][14][15][16][17] When both the artery and the vein require grafting, simultaneous vein grafts can be placed, or an arteriovenous loop can be created for later use following a brief period of maturation. Although the concept has been described previously, larger scale studies specific to the head and neck have yet to be reported.…”

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confidence: 99%

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Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients

et al. 2023

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Background The utilization of an arteriovenous loop is an underreported technique that affords the creation of reliable vascular options. Understanding the efficacy and impacting variables of microvascular reconstruction with an arteriovenous loop can be critical to its use. Methods Multi‐institutional study of 36 patients who underwent vein grafting or AV loop with free tissue transfer. Results 58.3% of patients received prior radiation and 38.9% prior flap reconstruction. Flap success for vein grafting was 76% and AV loop was 100% (p = 0.16). Success for the radiated cohort was 90.5% and non‐radiated 80% (p = 0.63). Flap success for the radiated, vein grafted patient was 83.3% and 100% flap success rate for radiated, AV loop patient (p = 0.49). Overall flap survival was 83.3% versus 97% overall success rate in the United States. Conclusion The AV loop is a viable modality for vessel‐depleted free tissue reconstruction. Radiation and previous surgery do not significantly impact flap success rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients

et al. 2023

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Creation of Superficial Temporal Arteriovenous Loop for Staged Free Tissue Transfer for Dural Coverage in the Setting of Radiation: A Case Report

Kumbla

Myers

2020

Craniomaxillofacial Trauma & Reconstruction Open

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Free tissue transfer for dural coverage can be challenging for various reasons. In the case of malignancy, patients often have received significant doses of radiation to the head and neck leading to fibrosis and osteoradionecrosis. Not only will free tissue transfer need to accommodate an often large defect but will need to protect intracranial contents. Recipient vessel quality and patency is often affected by comorbidities such as diabetes mellitus and coronary artery disease and can be compounded by radiation. Due to these factors, more proximal vessels in the head and neck are often pursued but due to insufficient length, often require vein grafts or arteriovenous loops to reach the donor vessels for anastomosis. This requires larger incisions and harvesting of lengthy veins. In this study, we discuss a technique of harvesting a small dorsal hand vein, that is hidden well in a hand crease, to create an arteriovenous loop between the superficial temporal vessels. Benefits include exploration of the recipient superficial temporal vessels prior to craniectomy without creating additional incisions, readily accessible recipient vessels to reach donor vessels without harvesting lengthy vein grafts, and allowing for arterialization of the superficial temporal vein leading to decreased venous congestion and thrombosis. While this can be done in 1 stage, we perform this in 2 stages to avoid an increased number of anastomoses and increased risk of flap failure. We present the case of an elderly male with multiple comorbidities and scalp osteoradionecrosis secondary to malignancy who this technique was successfully performed on.

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Efficacy of the Arteriovenous Loop for Free Flap Reconstruction in Patients with Complex Limb Trauma: Case Series and Literature Review

et al. 2020

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Background and objectives: Complex limb traumas are commonly treated with microsurgical reconstruction and free flaps. However, complications are frequent in patients affected by a previous trauma or comorbidity, atheromasia and a single valid vessel. Free flap reconstruction is indeed a challenging procedure in complex injuries, which may increase the risk of limb ischemia. The Arteriovenous loop (AVL) technique may be considered an efficient alternative treatment. We herein report our procedure and previous research regarding the AVL method using a two-step reconstruction in cases of complex high-energy limb injuries. Materials and Methods: In this single center retrospective cohort study, all the patients from 2014 to 2018 who underwent to AVL reconstruction were assessed. A total of six patients were included in the study for traumatic limb trauma. The two-stage technique was performed each time. The age and sex of patient, the time between stage one and two, the length of AVL loop and rate of free flap success were evaluated. Results: A total of seven AVL reconstructions were performed. The mean age of patients was 36 years old. Eight free flaps were performed; six free flaps were transferred to the vascular loops. The average time between stage one and two was 13 days. The mean length of the pedicle was 25 cm for the upper limb and 33.7 cm for the lower limb. All the free flaps successfully take root. In one case, a surgical revision was required the second day post-operatory due to venous congestion. Conclusions: AVL is a useful and safe technique in microsurgical reconstruction which will prevent vascular complications. Our investigations suggest the efficacy and feasibility of a two-step intervention in acute post-traumatic events. A single-step procedure should be preferred in chronic situation and oncologic reconstruction.

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Two-stage Reconstruction of the Scalp with Facial AV Loop

Cited by 3 publications

References 13 publications

Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients

Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients

Creation of Superficial Temporal Arteriovenous Loop for Staged Free Tissue Transfer for Dural Coverage in the Setting of Radiation: A Case Report

Efficacy of the Arteriovenous Loop for Free Flap Reconstruction in Patients with Complex Limb Trauma: Case Series and Literature Review

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