Early rupture of the arterial anastomoses with free flap survival

Skrbić, S; Stanec, Zdenko

doi:10.1016/0020-1383(95)00068-k

Cited by 17 publications

(6 citation statements)

References 9 publications

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“…neovascularization should follow early as 4 to 5 days from the surrounding tissue or will ultimately result in impaired circulation to the flap leading to higher chance of the flap failure if this phenomenon does not occur. [18][19][20] When either one branch supplying the heel is intact, the chance for flap survival becomes better as shown by our data. Although it still has a higher tendency to fail compared with when both branches are intact, it is not asignificant.…”

Section: Discussionmentioning

confidence: 76%

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Kim

Altiparmak

Pak

et al. 2020

J Reconstr Microsurg

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Background Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging. Patients and Methods This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis. Results Overall flap survival was 73% and resulted in limb salvage and functional ambulation. Total flap loss was 27% and the majority ended up with high-level amputation. Among the risk factors evaluated, the arterial status of the heel and ASA status significantly increased the odds for failure. When both arterial branches to the heel were impaired, the odds of failure were 80 times higher to fail (p< 0.05). Conclusion The vascularity of the surrounding tissue of the defect plays a critical role in overall success of diabetic heel reconstruction. Aggressive debridement using the angiosome concept is necessary to assure surrounding tissue has a good circulation. Despite the high chance of failure, success will lead to limb salvage and to reasonable functional ambulation whereas failure to salvage the heel will lead to higher level amputation. This warrants microsurgeons to make an effort to perform reconstruction to the heel defect after obtaining maximal vascularity after angioplasty.

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Section: Discussionmentioning

confidence: 76%

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Kim

Altiparmak

Pak

et al. 2020

J Reconstr Microsurg

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“…Twenty‐two articles described 32 flaps that survived and five articles described 11 flaps that failed after delayed vascular compromise without surgical intervention (Table ). Among the reported demographic information in both cohorts, most baseline characteristics of patients were not significantly different (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The range of postoperative days required for flap survival without surgical revision was between 7–20 days in 6 bone flaps; 12–35 days in 4 jejunal flaps; 4–35 days in 7 muscle flaps; and 4–19 days in 11 skin flaps . By recipient site, the range of postoperative days required for flap survival without surgical revision was 4–35 days in the head and neck; 9–35 days in the lower extremity; 7–12 days in the upper extremity; and 4–8 days in the breast …”

Section: Discussionmentioning

confidence: 97%

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

Yoon

Jones

2016

Microsurgery

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This analysis suggests that free flaps compromised by vascular thrombosis or pedicle ligation may survive with only conservative therapy when the event occurs after a minimal critical time period. Flap survival is more probable when arterial occlusion or pedicle ligation occurs after postoperative day 12, but this minimal critical period may be as low as 6 days for arterial occlusion. © 2016 Wiley Periodicals, Inc. Microsurgery 36:604-612, 2016.

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“…14 However, there are certain reports, which have shown that a period of 9 to 14 days allows for flap survival through neovascularization, despite the loss of axial blood supply. 8,14,20,21 Two flaps underwent partial necrosis after failure to re-establish axial blood supply at 11 days and 3 months respectively. 13,17 A possible explanation of partial flap necrosis at three months post-op was the presence of a refractory to multiple aspirations seroma, that probably prevented the development of adequate flap neovascularization from the recipient bed.…”

Section: Discussionmentioning

confidence: 99%

“…Very few cases have been reported in the literature to date; not only in free flap breast reconstruction, but also in other fields of free flap transfer. 7,8 As a result, little data is currently available on its causes and management.…”

mentioning

confidence: 99%

Vascular pedicle avulsion in free flap breast reconstruction: A case of diep flap salvage following early avulsion of venous anastomosis and literature review

2010

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Free flap vascular pedicle avulsion represents an extremely rare complication in reconstructive microsurgery. Very few cases have been reported in the literature, most of them identified in free flap breast reconstruction. As a result, little data is currently available on the etiology and treatment of this rare complication. Herein, we report a unique case of early venous anastomosis avulsion following free DIEP flap transfer for delayed breast reconstruction. Venous outflow was successfully restored with the use of an interposition vein graft, and the flap survived completely. In addition, the relevant literature is reviewed; and the possible causes, preventive strategies, and management options are analyzed.

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Early rupture of the arterial anastomoses with free flap survival

Cited by 17 publications

References 9 publications

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

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

Vascular pedicle avulsion in free flap breast reconstruction: A case of diep flap salvage following early avulsion of venous anastomosis and literature review

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