An Anatomic Review of the Delay Phenomenon

Taylor, G. Ian; Corlett, Russell J.; Caddy, Christopher M.; Zelt, Ronald G.

doi:10.1097/00006534-199203000-00002

Cited by 208 publications

(105 citation statements)

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“…De igual manera, existe evidencia de los cambios asociados al diferimiento sobre el sistema venoso, donde se reporta la regurgitación de las venas y el aumento del drenaje venoso (17). Varios estudios concluyen que los cam- bios en el flujo venoso durante el diferimiento obedecen a un proceso multifactorial; se proponen 2 teorías para explicar el fenómeno: la ruta del bypass, donde existen conexiones macrovenosas (venas comunicantes) y conexiones microvenosas (venae vasorum) y la ruta de la incompetencia vascular, por alteraciones estructurales de las válvulas, factores luminales o neurohumorales (18)(19)(20).…”

Section: Discussionunclassified

Una nueva experiencia clínica: Colgajo safeno interno diferido

Vargas

Posso

2010

Cir. plást. iberolatinoam.

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Wolff I, G.A. Una nueva experiencia clínica: Colgajo safeno interno diferidoA new clinical experience: the delayed reverse saphenous flap ResumenLos defectos de tejidos blandos de la pierna y el pie cuasados por traumatismos, tumores o infecciones, requieren frecuentemente procedimientos de cobertura mediante el empleo de colgajos. El colgajo safeno interno ha demostrado ser una excelente opción por su versatilidad y su poca morbilidad en el área donante. El diferimiento es un procedimiento útil para reducir las complicaciones vasculares de los colgajos, en pacientes con factores de riesgo añadidos. Su fisiología ha sido estudiada detalladamente, pero aún persisten interrogantes en torno a su uso y al periodo de diferimiento.Presentamos nuestra experiencia clínica con el uso de colgajos diferidos en 2 casos de reconstrucción de pie y tobillo secundarios a traumatismos, en los que se presentó sufrimiento vascular agudo al realizar el colgajo safeno interno reverso. El período de diferimiento varió entre los 7 y los 10 días.Los resultados postoperatorios fueron satisfactorios. Se presentó solo un complicación consistente en necrosis de los bordes de uno de los colgajos (menor del 1%).En conclusión, creemos que el diferimiento de los colgajos regionales es una herramienta útil para reducir la tasa de complicaciones vasculares en los mismos. Nuestra experiencia con el colgajo safeno interno diferido, reportada por primera vez según nuestro conocimiento, confirma la utilidad del procedimiento en este tipo de colgajo, demostrando que aún en condiciones de riesgo vascular esta modificación del colgajo se presenta como una opción alternativa para la reconstrucción exitosa de este tipo de defectos. AbstractComplex soft tissue defects of the distal third of the leg and foot represent a challenge in the reconstructive. The internal saphenous flap is a frequently used option for lower leg reconstruction because its versatility and minimal donor site morbidity. The commonly known delay procedure is an alternative. The concept of delay was clearly explained years ago, but still there is no consensus about the surgical technique and the delay period.This report presents our experience with delayed reverse saphenous flaps in 2 cases where acute vascular compromise was evident when the flap was rotated to the defect. The delay period was between 7 to 10 days.All flaps survived.Only one complication was presented in one of the flaps showing minimal necrosis that was debridated on the second procedure.As a conclusión, the delay procedure used in regional flaps for soft tissue coverage of lower leg and foot, is a useful tool in order to reduce vascular complication rates. Our experience with delayed reverse saphenous flaps, reported for the first time to our knowledge, confirms the utility of this procedure, proving that even when there are vascular risk factors, this flap modification is a successful alternative for lower leg and foot reconstruction.

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Section: Discussionunclassified

Una nueva experiencia clínica: Colgajo safeno interno diferido

Vargas

Posso

2010

Cir. plást. iberolatinoam.

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“…30 It may be that the smoothing effect noted in these experiments and illustrated in Figures 5 and 6 indicates a disturbance in the usual intramuscular vascular homeostatic mechanisms during flap mobilisation, so adding qualitative evidence for the role of choke vessels in the delay phenomenon. 31 Again, further investigation in human muscles is required to support or refute this possibility. …”

Section: Measurements In Muscles In Situ and Mobilised As Flapsmentioning

confidence: 99%

The nutrition of active muscle flaps

Greenbaum¹

2005

Ann R Coll Surg Engl

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In the last 25 years, techniques utilising muscle flaps to perform mechanical work have become part of the reconstructive surgeon's repertoire. In this paper, these techniques and the particular physiological challenges faced by active flaps are discussed and a sub-classification of muscle flaps into passive and active is proposed. A series of experiments are described that were designed to compare local pO 2 and gaseous perfusion, at multiple sites in pedicled tibialis anterior muscle flaps and controls, using specially developed dual amperometric microelectrodes, in an in vivo rabbit model. No significant difference in perfusion was found comparing flaps and controls until the flap's vascular pedicles were divided and ligated, and then flap perfusion fell to zero. Flap and control oxygenation varied significantly only during mobilisation and again, after pedicle division and ligation (F[13,55] = 12.3; P < 0.001)]. This absence of functional ischaemia as a consequence of mobilisation in the model used suggests the practice of delaying electrical conditioning of muscle flaps in dynamic cardiomyoplasty and neoanal sphincteroplasty might be unnecessary if these data are reproduced in human latissimus dorsi muscle. The relevance of these findings to free flap oxygen consumption and to the delay phenomenon is discussed.

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“…Other options are to "supercharge" the flap with an additional microvascular arterial anastomosis in the axilla (195), to "recharge" (14,15,144) the random side by anastomosing the deep inferior epigastric artery on the axial side to the contralateral artery, which must be included in the flap (parasite) with part of the rectus muscle, or to reconstruct the breast after a delay procedure. Several delay procedures have been proposed such as preelevating the island paddle (174), ligation of the dominant arterial supply (29,166), ligation of the deep inferior epigastric artery combined with skin island delay (65) or embolization of the deep inferior epigastric artery (140) before flap transfer. Such procedures have been shown to cause vasodilation within the delayed TRAM flaps in both clinical (29) and experimental studies (33,106).…”

Section: Pedicled and Free Tram Flapmentioning

confidence: 99%

“…This phenomenon is presumably due to postoperative inflammation and partial denervation of the severed rectus abdominis muscle, which causes vasodilation (159) and consequently increases blood flow (12). An additional explanation is the absence of the inferior epigastric artery, which increases the flow in the superior epigastric system (166).…”

Section: Pre-and Postoperative Blood Flow In Free Flaps and The Recipmentioning

confidence: 99%

“…These include ligation of the inferior epigastric arteries (29,166), ligation of the deep inferior epigastric artery combined with elevation of the skin island (65) and embolization of the deep inferior epigastric artery (140). Such procedures have been shown to cause vasodilation within the delayed TRAM flaps in both clinical (29) and experimental studies (33,106).…”

Section: Pre-and Postoperative Blood Flow In Free Flaps and The Recipmentioning

confidence: 99%

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