Effects of venous hypertension on rabbit free flap survival

Rooks, Michael D.; Gould, John; Masear, Victoria R.; Powell, Jack H.; Gould, Robert N.

doi:10.1002/micr.1920120406

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…5 In a study of Rooks et al on the effect of venous hypertension on rabbit free flap survival, a correlation between the flap failure and venous hypertension was determined, suggesting that venous superdrainage resulted in greater free flap survival. 9 In our study, group III which had the venous superdrainage, showed significantly higher arterial blood pressure than the control group, suggesting that reduced venous pressure led to increase in arterial blood perfusion because of the decline in venous congestion and peripheric vascular resistance. This finding also proves that venous congestion is already present in this flap model, and venous superdrainage overcomes it successfully, resulting in increase in arterial blood perfusion and pressure.…”

Section: Discussionmentioning

confidence: 79%

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Vascular pressure monitorization for necessity of vascular augmentation in a rat extended abdominal perforator flap model

Gümüş

Erkan²,

Erçöçen

2012

Microsurgery

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In case blood perfusion compromises, vascular enhancement with arterial supercharge or venous superdrainage can increase viability of the flap. In this study, vascular pressure monitorization was used in a rat extended abdominal perforator flap model to reveal intraoperative vascular compromise and the need for vascular augmentation. A rat abdominal perforator flap was designed, which was based on the right second cranial perforator of epigastric artery. Vascular pressures of the flap were monitored continuously for 60 min, by catheters placed in the right superficial inferior epigastric artery and vein. Forty rats were divided into four experimental groups, as follows: group 1 (n = 10, no vascular augmentation), group II (n = 10, arterial supercharge), group III (n = 10, venous superdrainage), and group IV (n = 10, arterial and venous augmentation). Arterial supercharge and/or venous superdrainage were performed by using the left superficial inferior epigastric artery and vein. After the rats were sacrificed on the 7th day, total flap area and necrotic regions were evaluated. Mean arterial blood pressure was found significantly lower (P < 0.05) and mean venous blood pressure was measured significantly higher (P < 0.05) in group I than the groups II, III, and IV. Flap survival area was also larger in the groups II, III, and IV than the group I (P < 0.05). The results of this experimental study demonstrate that arterial insufficiency and venous congestion are almost always present in the rat extended abdominal perforator flap model, similar to deep inferior epigastric perforator flap. When such an extended perforator flap is used, arterial and venous pressure monitorization may be considered as a tool to support intraoperative clinical findings to reveal the need of vascular augmentation and ascertain flap viability.

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Section: Discussionmentioning

confidence: 79%

“…[5][6][7][8][9] In a rat deep inferior epigastric perforator flap model, Hallock showed that venous supercharging provided greater flap survival by means of an alternative venous outflow tract. It is advisable for perforator flaps to overcome venous congestion.…”

Section: Discussionmentioning

confidence: 99%

Vascular pressure monitorization for necessity of vascular augmentation in a rat extended abdominal perforator flap model

Gümüş

Erkan²,

Erçöçen

2012

Microsurgery

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“…In addition to a compressive local environment of the lymphedematous extremity, long standing venous compression potentially contributed to an increased propensity for thrombosis due to vascular changes from long standing venous hypertension from a proximal compression or simply from a change in blood flow. In an experimental free flap model, blood flow was shown to decrease as the venous pressure increases and a correlation between free flap failure and venous hypertension was established . Given the issues we encountered, particularly with venous complications, we suggest two recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…In an experimental free flap model, blood flow was shown to decrease as the venous pressure increases and a correlation between free flap failure and venous hypertension was established. 18 Given the issues we encountered, particularly with venous complications, we suggest two recommendations.…”

Section: Case 1: Left Lower Limb Lymphedema With Venous Occlusionmentioning

confidence: 99%

Lymphedema and concomitant venous comorbidity in the extremity: Comprehensive evaluation, management strategy, and outcomes

Sachanandani

Chu

et al. 2018

Journal of Surgical Oncology

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Backgroud The optimal approaches for concurrent vascular lesions with limb lymphedema are not well established. The purpose of the study was to investigate the outcome of the surgical management of lymphedema with concomitant vascular lesions. Methods Between August 2010 and November 2015, 15 consecutive patients with extremity lymphedema and concomitant vascular lesions treated with vascularized lymph node flaps were reviewed. The patients had vascular interventions discovered during workup for lymphedema surgery. Outcomes were assessed using circumferential difference (CD) and circumferential reduction rate (CRR) at 12‐month and final follow‐up visits. Results Vascular lesions (n = 15) included proximal arterial occlusion ( n = 1), vascular malformation ( n = 2), and proximal venous compression/stenosis ( n = 12). Concomitant vascular lesions had an incidence of 15.8% in patients that underwent vascularized lymph node transfers (VLNTs). We had 100% VLNT survival rate and average number of episodes of cellulitis after VLNTs decreased significantly ( p < 0.05). The CRR for the below knee/elbow measurement at 12‐months follow‐up was significantly higher for patients that underwent vascular intervention for venous lesions before VLNT instead of concurrently or after (23.7% vs 12.2%, P = 0.23). Final mean CRR was 23.7% and 12.2% respectively. Conclusion Preoperative workup of concomitant vascular lesions is important for lymphedema management. We suggest appropriate vascular intervention should be done prior to VLNT to maximize the short‐term and long‐term outcomes.

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“…These grafts are usually larger then the artery by two or more times, and this may be another reason for flap failures. 12,[30][31][32][33][34][35] All vein grafts should be marked and reversed when used in arterial reconstruction, as it has been shown that even the smallest digital vessels contain valves. 36 When the veins are reversed, the diameter discrepancy can become more obvious.…”

Section: Discussionmentioning

confidence: 99%

Increasing Vessel Diameter with the Open Y Technique for Diameter Discrepancy

Akan¹,

Çakır²,

Aköz³

2004

J reconstr Microsurg

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Free tissue transfers have increasingly become the mainstay of plastic surgery for the last two decades. Size discrepancy between the vessels in microsurgery is frequently encountered in clinical practice and may potentially be an important factor in the patency of the anastomosis. A rat model has been devised to improve the diameter discrepancy in microvascular anastomosis. Twenty Wistar rats have been used for this purpose. The external jugular vein was cut 1 mm distally from the bifurcation of the anterior and posterior facial veins. Both legs of the resultant Y-shaped vessel were united after inserting microscissors from one leg and exiting from the other. Performing an end-to-end anastomosis between the vein, which acquired an increased diameter as a result of this procedure, and the carotid artery prepared in the neck, helped to create an arteriovenous shunt. Patency was assessed in the operated rats 2 weeks later. In order to achieve a better understanding of the advantages of this technique, another study was carried out. In this subsequent study, specimens were collected from fresh sheep cadavers, including the brachiocephalic trunk, right common carotid, and right subclavian arteries. Different specimens were compared from each of the vessels and also from each of the subclavian and carotid arteries after they were joined together with the open Y technique and increased diameters of the vessels are obtained. As a result, the authors demonstrated that size discrepancy between the vessels was decreased, patency with a percentage of 94.1 was obtained, and when specimens from the fresh cadavers were evaluated, a reasonable gain was achieved. (p < 0.0001).

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Effects of venous hypertension on rabbit free flap survival

Cited by 9 publications

References 18 publications

Vascular pressure monitorization for necessity of vascular augmentation in a rat extended abdominal perforator flap model

Vascular pressure monitorization for necessity of vascular augmentation in a rat extended abdominal perforator flap model

Lymphedema and concomitant venous comorbidity in the extremity: Comprehensive evaluation, management strategy, and outcomes

Increasing Vessel Diameter with the Open Y Technique for Diameter Discrepancy

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