Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: A review of the literature

Yoon, Alfred P.; Jones, Neil F.

doi:10.1002/micr.30082

Cited by 51 publications

(42 citation statements)

References 44 publications

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“…However, at least one study has shown that the minimal critical period for flap survival for arterial occlusion is six days. 21 Therefore, we believe that a barrier would not have affected the tissue viability and thereby the visual appearance of the flap three days after surgery.…”

Section: Discussionmentioning

confidence: 95%

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

Zötterman

Tesselaar

Farnebo

2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Background: We have evaluated the use of Laser Speckle Contrast Imaging (LSCI) in the perioperative planning in reconstructive surgery. The aim of the study was to investigate if LSCI can predict regions with a high risk of developing postoperative necrosis. Our hypothesis was that, perioperatively, such regions have perfusion values below a threshold value and show a negative perfusion trend. Methods: A porcine flap model based on the cranial gluteal artery perforator was used. Images were acquired prior to surgery, immediately after surgery (t=0), after 30 minutes (t=30 min) and after 72 hours (t=72 h). Regions of Interest (ROI) were chosen along the central axis of the flap. Clinical evaluation of the flap was done during each time point. Results: At t=72h a demarcation line could be seen at 15.8±0.4 cm from the proximal border of the flaps. At t=0 perfusion decreased gradually from proximal to distal ROI. At t=30 min perfusion was significantly lower in ROI distal to the final demarcation line compared to t=0 and every flap these ROI had a perfusion >25 PU. At t=72 perfusion in ROI proximal of this line returned to baseline levels, while perfusion in distal ROI remained low. Conclusions: In our model a decrease in perfusion during the first 30 minutes after surgery, and a perfusion <25 PU at t=30 min was a predictor for tissue morbidity 72 hours after surgery, indicating that LSCI is a promising technique for perioperative monitoring in reconstructive surgery.

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Section: Discussionmentioning

confidence: 95%

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

Zötterman

Tesselaar

Farnebo

2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Moreover, Jones, Kuzon, Shestak, and Roth () also presented a case of a disrupted jejunal pedicle on the 12th postoperative day and survival of the flap. Yoon & Jones () reviewed the literature and concluded that a longer postoperative period before ligation or obstruction of the pedicle is required for jejunal flap survival. However, these reports did not recommend subtotal liberation of the flap from the surrounding tissues, but they only indicated pedicle transection.…”

Section: Discussionmentioning

confidence: 99%

“…also presented a case of a disrupted jejunal pedicle on the 12th postoperative day and survival of the flap Yoon & Jones (2016). reviewed the literature and concluded that a longer postoperative period before ligation or obstruction of the pedicle is required for jejunal flap survival.…”

mentioning

confidence: 98%

Vascular pedicle division during free flap re‐inset in pharyngoesophageal reconstruction

Yeğin¹,

Chen

2019

Microsurgery

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Background Free intestinal flaps for pharyngolaryngoesophagus reconstruction may require revision operations, including free flap re‐inset for functional improvement. This report aimed to present our experience on vascular pedicle division at the secondary procedure of free flap re‐inset for functional improvement in pharyngoesophageal reconstruction. Patients and Methods Eight male and seven female patients, with a mean age of 52 years old (range: 28–78 years), underwent pharyngoesophageal stricture (n = 7) and hypopharynx carcinoma reconstruction (n = 8) with three free jejunal and 12 free ileocolonic flaps. During revision procedure to shorten the flap for functional improvement, which was performed at 3 months after the initial operation, there were 11 venous and 4 arterial pedicle division cases. The intestinal flap circulation signs, such as presence of normoperistalsis, pink color, moderate secretion, and bleeding at puncture site, were observed for 1 hr. Results No venous pedicle divisions required reanastomosis. However, all arterial pedicle division cases required immediate restoration with a vein graft because of immediate intestinal changes. No postoperative complications were seen, excluding a patient with anterior wall reconstruction who had arterial division and reanastomosis. Patients were followed up for a median duration of 28 months. Conclusion For revision operations involving free intestinal flaps, the arterial pedicle must be protected or repaired if transected, whereas the venous pedicle does not necessitate such a maneuver.

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“…A study in a swine model has shown that neovascularization between the flap and the surrounding tissue becomes well established by the 8th day after free tissue transfer (Black, Chait, O'Brien, Sykes, & Sharzer, ) and serves as the basis for the staged inset principle. A clinical study determined that free flaps are able to survive a pedicle occlusion only after postoperative day 10 (Granzow, Li, Caton, & Boyd, ; Yoon & Jones, ) Another case series that investigated the effect of early pedicle loss documented that 50% of their flaps were able to survive completely after the loss of arterial inflow on the postoperative day 7 (Salgado et al, ) However, considering the complexity of head and neck procedures and confounding risk factors such as preoperative radiotherapy and scarring of the recipient site tissue bed, a period of 3–4 weeks is preferred. An advantage of the staged flap inset is the much shorter and simpler operation of the second procedure.…”

Section: Discussionmentioning

confidence: 99%

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

et al. 2018

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Introduction Microsurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions. Methods From February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset. Results Fifty‐one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate re‐exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2% and the average time between 2 stages was 24 days (range, 21–28). Conclusion Staged flap inset can improve free flap survival in complex head and neck reconstructions.

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Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: A review of the literature

Cited by 51 publications

References 44 publications

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

The use of laser speckle contrast imaging to predict flap necrosis: An experimental study in a porcine flap model

Vascular pedicle division during free flap re‐inset in pharyngoesophageal reconstruction

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

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