Ipsilateral Arteriovenous Loop and Latissimus Dorsi Free Flap for Knee Reconstruction in an Elderly Patient: A Case Report

Parra, Luis; Andres, J.; Robustillo, Manuel; García, C Lorca; Iglesias, Israel; Diaz, Antonio Gutierrez

doi:10.29252/wjps.7.3.377

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…AV loop creation and free flap transfer can either be performed as a single surgical procedure (single-staged approach) or as two separate surgical interventions with the free tissue transfer usually performed between one and two weeks after AV loop placement (two-staged approach) [11]. The efficacy of free flap reconstruction combined with an AV loop in terms of patient outcome, limb salvage and flap survival has been confirmed in the literature by several study groups [12][13][14][15][16]. Despite its successful application, it must be noted that this type of free flap surgery is reserved for a highly specialized patient population, with thromboembolic events still remaining a common risk factor for flap failure.…”

Section: Introductionmentioning

confidence: 96%

Intraoperative Blood Flow Analysis of Free Flaps with Arteriovenous Loops for Autologous Microsurgical Reconstruction

Geierlehner,

Horch,

Ludolph

et al. 2023

JCM

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Background: Arteriovenous (AV) loops help to overcome absent or poor-quality recipient vessels in highly complex microvascular free flap reconstruction cases. There are no studies on blood flow and perfusion patterns. The purpose of this study was to evaluate and compare intraoperative hemodynamic characteristics of AV loops followed by free tissue transfer for thoracic wall and lower extremity reconstruction. Methods: this prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the assessment of blood flow volume, arterial vascular resistance and intrinsic transit time at the time of AV loop construction and on the day of free flap transfer. Results: A total of 11 patients underwent AV loop creation, of whom five required chest wall reconstruction and six required reconstruction of the lower extremities. In seven of these cases, the latissimus dorsi flap and in four cases the vertical rectus abdominis myocutaneous (VRAM) flap was used as a free flap. At the time of loop construction, the blood flow volume of AV loops was 466 ± 180 mL/min, which increased to 698 ± 464 mL/min on the day of free tissue transfer (p > 0.1). After free flap anastomosis, the blood flow volume significantly decreased to 18.5 ± 8.3 mL/min (p < 0.001). There was no significant difference in blood flow volume or arterial vascular resistance between latissimus dorsi and VRAM flaps, nor between thoracic wall and lower extremity reconstruction. However, a significant correlation between the flap weight and the blood flow volume, as well as to the arterial vascular resistance, was found (p < 0.05). Conclusion: This is the first study to perform intraoperative blood flow and hemodynamic measurements of AV loops followed by free tissue transfer. Our results show hemodynamic differences and contribute to deeper understanding of the properties of AV loops for free flap reconstruction.

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Section: Introductionmentioning

confidence: 96%

Intraoperative Blood Flow Analysis of Free Flaps with Arteriovenous Loops for Autologous Microsurgical Reconstruction

Geierlehner,

Horch,

Ludolph

et al. 2023

JCM

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“…1 Arteriovenous loops have previously been described in the literature as an adjunct to reconstruction, and can provide fresh and stable, healthy vasculature for free-tissue anastomosis within an otherwise complicated radiated field. [2][3][4][5][6][7][8][9][10][11] Generally, an autologous vessel is ideal as it contains the patient's own intima and its milieu of autologous immune factors preventing local inflammatory responses. Autologous saphenous and cephalic veins generally prove to be reliable options.…”

mentioning

confidence: 99%

Potential Complications With Cryopreserved Cadaveric Veins in Arteriovenous Loop Formation for Head and Neck Microvascular Reconstruction

Anderson

Harrison

Garret

et al. 2021

Journal of Craniofacial Surgery

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Vessel depletion in the head and neck from radiation or previous surgical intervention adds to the operative complexity by limiting reconstructive options. Arteriovenous (AV) loop vascular grafts provide a conduit to bypass these nonviable local vessels to provide adequate blood flow. In certain situations, autologous donor vascular options are deficient or not readily available for creation of the AV loop. Cadaveric vein grafts provide an alternative option in these circumstances, but the efficacy and safety has not yet been delineated. In this study we discuss our experience utilizing cryopreserved cadaveric vein grafts for AV loop creation in head and neck reconstruction. In our initial cohort we aim to elucidate potential challenges and complications associated with the use of cadaveric vein grafts.

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One vs. two‐stage arteriovenous loops in lower extremity reconstruction with free flaps: Systematic review and metanalysis

Asensio‐Ramos,

Sanz‐Medrano,

Soldado

et al. 2024

Microsurgery

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BackgroundArteriovenous loops are one of the main therapeutic alternatives to address the absence of recipient vessels in lower extremity microsurgical reconstruction. However, there is no consensus on whether to perform them in one or two surgical stages. The objective of this work is to determine whether the outcome of lower limb free flaps anastomosed to vascular loops depends on the number of surgical stages.Materials and MethodsA literature review was conducted, following PRISMA guidelines, on vascular loops and free flaps in lower limb. Survival rate, as well as major and minor complications were studied. A forest plot and Pearson's chi‐square were used for statistical analysis. Study quality was assessed in duplicate using Methodological Index for Non‐Randomized Studies (MINORS) and Joanna Briggs Institute (JBI) tool. This study was registered on PROSPERO.ResultsThirty‐two articles using free flaps anastomosed to vascular loops in lower limb, either one or two‐stage, were selected. A total of 296 flaps were included, 52% (n = 154) in one and 48% (n = 142) in two surgical times. No statistically significant differences were found in the survival rate (OR = 1.85, 95% CI 0.62; 5.47, p = .09 and p = .344) or major complications (OR = 0.70, 95% CI 0.31; 1.57, p = .56 and p = .92) of flaps between both groups.ConclusionsAccording to the available evidence, the outcome of free flaps anastomosed to vascular loops in the lower limb does not depend on the number of surgical stages they undergo. Although there is some heterogeneity in the groups studied, the decision on the number of procedures to be performed should be determined by the surgeon, concerning the clinical situation of the patient, as well as to the vascular, bone and soft tissue status of the extremity.

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Ipsilateral Arteriovenous Loop and Latissimus Dorsi Free Flap for Knee Reconstruction in an Elderly Patient: A Case Report

Cited by 5 publications

References 18 publications

Intraoperative Blood Flow Analysis of Free Flaps with Arteriovenous Loops for Autologous Microsurgical Reconstruction

Intraoperative Blood Flow Analysis of Free Flaps with Arteriovenous Loops for Autologous Microsurgical Reconstruction

Potential Complications With Cryopreserved Cadaveric Veins in Arteriovenous Loop Formation for Head and Neck Microvascular Reconstruction

One vs. two‐stage arteriovenous loops in lower extremity reconstruction with free flaps: Systematic review and metanalysis

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