Free flap transplantation using an extracorporeal perfusion device: First three cases

Wolff, Klaus‐Dietrich; Mücke, Thomas; Bomhard, Achim von; Ritschl, Lucas M.; Schneider, J.; Humbs, Martin; Fichter, Andreas M.

doi:10.1016/j.jcms.2015.11.007

Cited by 36 publications

(20 citation statements)

References 33 publications

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“…Many varieties of new free style perforator flaps appear wherever on the body as well as growing applications of tissue expanders in pre-expanded super-thin skin flaps (8). In addition, another potential field represent trials carried-out in robotic assisted surgery in free flaps harvesting or mini-perforator flaps using an extracorporeal perfusion etc (13).…”

Section: Resultsmentioning

confidence: 99%

The Angiosomal Concept: an Overview And 3 illustrative Cases

Lovětínská¹,

Zálešák²,

Klein³

et al. 2019

Mil. Med. Sci. Lett.

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The angiosomal theory and its clinical application is not the latest science discovery. Nevertheless, its importance in plastic reconstructive surgery is still often underestimated when planning surgical procedures. Knowing and understanding the main problem can be useful not only for planning the flap design but also for survival of large flaps and also the wound healing process. Learning more about the complexity of skin and soft tissue anatomy and the vasculatory system can be beneficial for a variety of medical subspecialities. The article is divided into two parts. Part one is an introduction to the history, anatomy and physiology of angiosomes and perforator flaps. The second part describes practical applications in 3 various cases treated at the

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Section: Resultsmentioning

confidence: 99%

The Angiosomal Concept: an Overview And 3 illustrative Cases

Lovětínská¹,

Zálešák²,

Klein³

et al. 2019

Mil. Med. Sci. Lett.

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“…There is one report were flaps were extracorporal perfusion with whole blood for 10–13 days until they became independent. However, 12–25 packs of blood were needed for this endeavor (Wolff, Mucke, von Bomhard, et al, 2016). Such a device was also used for short‐term extracorporal perfusion by the same group for up to 4 hr in radial forearm flaps (Fichter et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Transplantation of a latissimus dorsi flap after nearly 6 hr of extracorporal perfusion: A case report

et al. 2020

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Prolonged ischemia of tissues inevitably leads to their necrosis. This is especially relevant in the case of transplantation or replantation. In such situations, reperfusion in a timely manner might not be possible due to transportation times or other unforeseen complications. Therefore, a readily available and simple method to oxygenate the tissue and thus widen the time frame to reperfusion seems desirable. Here, we present the case of extracorporal perfusion of a latissimus dorsi (LD) flap that was successfully transplanted after nearly 6 hr of ischemia. A 41‐year‐old patient suffered multiple injuries including complete severance of the popliteal artery requiring emergency bypass. After stabilization of the patient and subsequent debridement, a LD flap was performed for soft tissue coverage. However, there was an acute occlusion of the bypass during flap inset. To salvage the free flap, a one‐way extracorporal perfusion of the flap with heparinized isotonic saline solution was performed for a total of 5 hr and 47 min. The flap survived with minimal tip necrosis. This case report describes the application of a simple extracorporal perfusion technique for salvage of a free flap over a prolonged ischemia time and discusses the relevant literature. Due to its ease and quickness of application as well as ubiquitous availability, it might serve as a valuable tool in cases of acute problems with the recipient vessels or other incidents where several hours of ischemia time are to be anticipated.

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Section: Discussionmentioning

confidence: 99%

“…Müller et al were able to successfully reimplant porcine forelimbs after a period of 12 h of EP [20]. Wolff et al (2016) described a series of three cases using whole blood for EP to achieve a free flap transfer without vascular anastomosis [30]. Hereby, EP was performed as a bridge until autonomization of the flaps occurred, and the flaps became independent from the external blood supply.…”

Section: Discussionmentioning

confidence: 99%

“…However, using unidirectional perfusion requires a high amount of the patient's blood. According to Wolff et al (2016), EP was necessary for a successful free flap transfer since vessel-depleted necks left no possibility for vascular anastomosis. Being a well-established technique, even in the case of lower limb reconstruction with long distances [31][32][33][34], it is our opinion that it is implausible that the use of vascular loops or vein grafts in a neck reconstruction with very short distances would not be favorable to unidirectional EP with whole-blood.…”

Section: Discussionmentioning

confidence: 99%

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Tissue Viability of Free Flaps after Extracorporeal Perfusion Using a Modified Hydroxyethyl Starch Solution

Taeger

Friedrich

Horch

et al. 2020

JCM

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Background: In free flap surgery, tissue is stored under hypothermic ischemia. Extracorporeal perfusion (EP) has the potential to extend storage time and the tissue’s perspective of survival. In the present study, the aim is to improve a recently established, simplified extracorporeal perfusion system. Methods: Porcine musculus rectus abdominis were stored under different conditions. One group was perfused continuously with a simplified one-way perfusion system for six hours, while the other received only a single flush but no further treatment. A modified hydroxyethyl starch solution was used as a perfusion and flushing solution. Vitality, functionality, and metabolic activity of both groups were analyzed. Results: Perfused muscles, in contrast to the ischemically stored ones, showed no loss of vitality and significantly less functionality loss, confirming the superiority of storage under continuous perfusion over ischemic storage. Furthermore, in comparison to a previous study, the results were improved even further by using a modified hydroxyethyl starch solution. Conclusion: The use of EP has major benefits compared to the clinical standard static storage at room temperature. Continuous perfusion not only maintains the oxygen and nutrient supply but also removes toxic metabolites formed due to inadequate storage conditions.

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Free flap transplantation using an extracorporeal perfusion device: First three cases

Cited by 36 publications

References 33 publications

The Angiosomal Concept: an Overview And 3 illustrative Cases

The Angiosomal Concept: an Overview And 3 illustrative Cases

Transplantation of a latissimus dorsi flap after nearly 6 hr of extracorporal perfusion: A case report

Tissue Viability of Free Flaps after Extracorporeal Perfusion Using a Modified Hydroxyethyl Starch Solution

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