Cold ischemia in microvascular breast reconstruction

Lee, T B S David; Lee, Gordon

doi:10.1002/micr.20739

Cited by 9 publications

(2 citation statements)

References 12 publications

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“…Therefore, leaving flaps in cold ischemia can provide extra time. Lee and Lee [12] also reported that cold ischemia time up to 5 hours is safe, and is not associated with an increased risk of flap complications. Consequently, we cooled the flap, allowing us to prolong the ischemia time without compromising the success of the operation.…”

Section: Discussionmentioning

confidence: 94%

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Deep Inferior Epigastric Perforator Flap Breast Reconstruction in a Patient with Huge Uterine Leiomyoma

Kim

2017

Arch Aesthetic Plast Surg

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Section: Discussionmentioning

confidence: 94%

“…Animal and experimental studies have shown that elevated flaps can be kept in cold ischemia to provide a longer, yet safe, time to use the free flaps [12][13][14][15]. In addition, it is common to use hypothermia to prolong the amount of tolerated ischemia time in solid organ transplantation, such as the liver and kidney.…”

Section: Discussionmentioning

confidence: 99%

Deep Inferior Epigastric Perforator Flap Breast Reconstruction in a Patient with Huge Uterine Leiomyoma

Kim

2017

Arch Aesthetic Plast Surg

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Free transverse rectus abdominis myocutaneous flap reconstruction of a massive lumbosacral defect using superior gluteal artery perforator vessels

Gaster¹,

Bhatt²,

Shelton³

et al. 2012

Microsurgery

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Despite significant advances in reconstructive surgery, the repair of massive lumbosacral defects poses significant challenges. When the extent of soft tissue loss, tumor resection, and/or radiation therapy preclude the use of traditional local options, such as gluteal advancement flaps or pedicled thigh flaps, then distant flaps are required. We report a case of a 64-year-old male who presented with a large sacral Marjolin's ulcer secondary to recurrent pilonidal cysts and ulcerations. The patient underwent wide local composite resection, which resulted in a wound measuring 450 cm(2) with exposed rectum and sacrum. The massive defect was successfully covered with a free transverse rectus abdominis myocutaneous flap, providing a well-vascularized skin paddle and obviating the need for a latissimus flap with skin graft. The free-TRAM flap proved to be a very robust flap in this situation and would be one of our flaps of choice for similar defects.

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Intra‐flap thrombosis secondary to acute sickle crisis: A case report

et al. 2012

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We present the case of a 40-year-old patient with sickle cell trait who underwent bilateral breast reconstruction with microvascular TRAM flap transfer. Intraoperatively, the patient developed arterial anastomotic thrombosis of the right breast flap. The left breast flap had already been harvested and was placed on ice. Both anastomoses were then successfully completed. Postoperatively, the patient developed a pulmonary embolism and heparin-induced thrombocytopenia. On postoperative day 12, the left cutaneous Doppler signals were lost, and exploration revealed a thrombosed pedicle and nonviable left breast flap. Pathologic specimen evaluation revealed sickled cells within the flap microvasculature. We believe that prolonged ischemia time and hypothermia precipitated erythrocyte sickling within the flap, causing intra-flap thrombosis that propagated to the pedicle. While sickle cell diseases are not a contraindication to free tissue transfer, we believe that flap cooling should be utilized with caution in this circumstance.

show abstract

Cold ischemia in microvascular breast reconstruction

Cited by 9 publications

References 12 publications

Deep Inferior Epigastric Perforator Flap Breast Reconstruction in a Patient with Huge Uterine Leiomyoma

Deep Inferior Epigastric Perforator Flap Breast Reconstruction in a Patient with Huge Uterine Leiomyoma

Free transverse rectus abdominis myocutaneous flap reconstruction of a massive lumbosacral defect using superior gluteal artery perforator vessels

Intra‐flap thrombosis secondary to acute sickle crisis: A case report

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