Free flap survival despite early loss of the vascular pedicle

Wise, Lcdr Sean R.; Harsha, M.; Kim, Namou; Hayden, Richard E.

doi:10.1002/hed.21354

Cited by 34 publications

(26 citation statements)

References 24 publications

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“…All flaps in this study had been anastomosed to the same arteries and vein, but the development of autonomization was found to be significantly different. The different values of free flaps show the different behavior of tissues transferred, especially in terms of autonomization and vulnerability of free flaps for flap failure and venous congestion 10, 27–29. The reliability of free flaps depends on the quality of tissue at the recipient 7.…”

Section: Discussionmentioning

confidence: 99%

Autonomization of free flaps in the oral cavity: A prospective clinical study

et al. 2012

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Controversy exists over how long a free flap is dependent on its pedicle and if neovascularization is different between flap types, recipient sites, and irradiated and nonirradiated patients. An understanding of the timing of this process should optimize the safety of secondary procedures involving the flap. In a prospective clinical study, hemoglobin oxygenation and capillary flow were measured in 50 flaps (25 forearm flaps, 15 osteocutaneous fibula flaps, and 10 anterolateral thigh flaps) 4 and 12 weeks postoperatively. The flaps were located at the floor of the mouth, cheek, or tongue (n = 39) or at the hard or soft palate (n = 11). Measurements were carried out using the O2C monitoring system under temporary digital occlusion of the pedicle. After 4 weeks, 17 free flaps were found to be autonomized indicated by the O2C measurements comparing both values before and after digital compression of the vascular pedicle. After 12 weeks, 41 patients had completion of free flap autonomization, as indicated by the HbO(2) and CF before and after pedicle compression. The location of free flap in the lower jaw (P < 0.0001 after 4 weeks, P = 0.013 after 12 weeks), fasciocutaneous radial forearm flaps after 4 weeks (P < 0.0001), and not irradiated recipient site after 4 weeks (P = 0.014) were found to be positive factors significantly influencing autonomization. In conclusion, free flap autonomization depends on several variables which should be considered before further surgery after free flap reconstruction as the transferred tissue can be still dependent on its pedicle.

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Section: Discussionmentioning

confidence: 99%

Autonomization of free flaps in the oral cavity: A prospective clinical study

et al. 2012

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“…A number of animal studies and case reports suggest that DIEP flaps can survive after separation from the IMA pedicle 7-9 days post-operatively [15,[64][65][66][67][68] if there is a cutaneous inset. Therefore, if the IMAs anastomosed to the DIEP pedicles are long enough to reach the coronary arteries, they can theoretically be disconnected from the DIEP flap and manoeuvred back into the thoracic cavity to be reused in CABG as needed.…”

Section: Disadvantagesmentioning

confidence: 99%

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Rozen

Guio-Aguilar

et al. 2012

Breast Cancer Res Treat

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We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG.

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“…Most prominently, compliance matching between the arterial wall and graft is absolutely crucial in ensuring long-term patency in the larger grafts made for coronary bypass, 8 but is less relevant at the microsurgical scale, where collaterals will promptly develop and only short-term patency is absolutely required. [9][10][11] The requirement for anastomotic strength and burst pressure will likely differ for the two diameter scales as well.…”

Section: Introductionmentioning

confidence: 99%

Generation, Endothelialization, and Microsurgical Suture Anastomosis of Strong 1-mm-Diameter Collagen Tubes

Nicolescu

et al. 2017

Tissue Engineering Part A

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Tissue-engineered vascular grafts that are based on reconstituted extracellular matrices have been plagued by weak mechanical strength that prevents handling or anastomosis to native vessels. In this study, we devise a method for making dense, suturable collagen tubular constructs of diameter £1 mm for potential microsurgical applications, by dehydrating tubes of native rat tail type I collagen and crosslinking them with 20 mM genipin. Crosslinked dense collagen tubes with 1 mm inner diameter yielded ultimate tensile strength of 342 -15 gF and burst pressure of 1313 -156 mm Hg, comparable to the strength of a rat femoral artery, and supported endothelial cell adhesion and growth. End-to-end anastomosis of 0.5-mm-diameter tubes to explanted arteries displayed anastomotic strength of 82 -21 gF, which is sufficient for surgical applications. In vivo implantation of cell-free tubes as interpositional grafts in the rat femoral circulation yielded stable anastomosis with blood flow for 20 min. Seeded dense collagen tubes represent a promising alternative to venous graft that can potentially be used to bridge between short artery stubs in replantation surgeries.

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Free flap survival despite early loss of the vascular pedicle

Abstract: After microvascular free tissue transfer, neovascularization sufficient to maintain flap viability independent of the primary vascular pedicle may occur by postoperative day 9. This early revascularization can also occur despite a history of radiotherapy.

Cited by 34 publications

References 24 publications

Autonomization of free flaps in the oral cavity: A prospective clinical study

Autonomization of free flaps in the oral cavity: A prospective clinical study

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Generation, Endothelialization, and Microsurgical Suture Anastomosis of Strong 1-mm-Diameter Collagen Tubes

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