Microcirculatory Disturbances Following the Passage of Emboli in an Experimental Free-Flap Model

Barker, John H.; Acland, Robert D.; Anderson, Gary L.; Patel, Jateen C.; Tangelder, Geert Jan

doi:10.1097/00006534-199207000-00015

Cited by 4 publications

(6 citation statements)

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“…The major insult to the tissue was not ischemia and reperfusion, as the ischemia time chosen is not long enough to initiate the corresponding mechanisms. The major insult was, instead, the injury to the pedicle artery, which generates platelet emboli from the thrombogenic arterial injury passing down into the microcirculation [4,5]. If the ischemia time chosen had been longer, we could not have excluded a different behavior in the microcirculation, observed by other researchers.…”

Section: Discussionmentioning

confidence: 98%

“…The incision was closed with five sutures (10-0 nylon on a 75-µm needle) in such a way that a full-thickness flap of the arterial wall was intentionally inverted into the lumen. In previous studies, this technique has been shown to consistently produce thrombi at the repair site and embolization downstream into the cremaster muscle microcirculation [5,6,15].…”

Section: Pedicle Artery Injurymentioning

confidence: 91%

“…These studies demonstrated showers of platelet emboli and large numbers of adherent leukocytes in the microvessels following the anastomotic repair. More importantly, subsequent studies showed that, following these events, capillary perfusion in the downstream microcirculation decreased significantly [5]. In yet another study using the same model, emboli were eliminated with heparin administration and still the decrease in capillary perfusion persisted [6].…”

Section: Introductionmentioning

confidence: 96%

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Effect of granulocytes on the microcirculation in free-flap surgery

Peter

Steinau²,

Barker

1998

Langenbeck's Archives of Surgery

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Section: Discussionmentioning

confidence: 98%

Section: Pedicle Artery Injurymentioning

confidence: 91%

Section: Introductionmentioning

confidence: 96%

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Effect of granulocytes on the microcirculation in free-flap surgery

Peter

Steinau²,

Barker

1998

Langenbeck's Archives of Surgery

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“…Dass auch den Thrombozyten bei der Entstehung des postischä-mischen Reperfusionsschadens eine zentrale pathophysiologische Bedeutung in der Plastischen Chirurgie zukommt, ist bekannt [3,9,20,46,53]. Dennoch ist die Bedeutung der Thrombozyten bei Ischämie und Reperfusion in einer Muskellappenplastik nur unzureichend aufgeklärt, da die In-vivo-Analyse der Thrombozytenaggregation und -adhäsion bisher kaum möglich war.…”

Section: Der Postischämische Reperfusionsschadenunclassified

Die Bedeutung der Mikrozirkulation in der Plastischen Chirurgie

Langer¹,

Galla²,

Steinau³

et al. 2004

Handchir Mikrochir plast Chir

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The article summarizes distinct microcirculatory models for use in surgical research with a special interest to plastic surgery. Methods for the quantitative analysis of the microcirculation in burns, flaps and wounds are presented. Vascularization of biomaterials can be observed by means of the dorsal skinfold chamber model in hamsters and mice. Developing capillary sprouts can be assessed by means of videomicroscopy and angiogenetic drugs can be tested using this model. Hairless mice allow for direct, long-term observation of the microcirculation in burns as well as during healing of dermal wounds. The pathophysiology of diabetic wound healing can also be studied. A mouse model to assess flap microcirculation during ischemia/reperfusion injury with special emphasis on platelet/endothelium interaction in vivo is described. Platelets adherent to the inner vessel wall are known to trigger compromised perfusion in flaps. The model allows us to test anti-thrombotic drugs. The use of a special microscopic device (OPS imaging) allows us to study the microcirculation at sites of burn injury and chronic wounds in humans. Microcirculatory research in plastic surgery has increased the understanding of the pathophysiology of vascularization of biomaterials, wound healing and ischemia/reperfusion.

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“…Armed with this information, we will be better prepared to prevent free flap and replant failure. For example: The upstream arterial microanastomosis can produce platelet emboli, which pass into the downstream microcirculation [64]. The number will increase with poor surgical technique.…”

Section: Microcirculatory Consequences Of Microvascular Surgerymentioning

confidence: 99%

Microcirculation Research for Microsurgeons: Basic Concepts and Potential Applications

et al. 2001

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The primary purpose of this review is to introduce the techniques of modern microcirculation research to reconstructive microsurgeons and trauma surgeons. When applied to clinically relevant situations, these techniques are powerful tools to elucidate the mechanisms regulating success or failure of a reconstructive procedure. Several phenomena at the microcirculatory level can have significant influence on the outcome of free flaps or replants. Most importantly these are ischemia/reperfusion injury, problems with wound healing and failure of downstream microcirculation due to thrombosis at the vascular anastomosis.Traditional research methods to assess free flap or replant failure utilize patency of the repaired vessel as the principal parameter. This all-or-nothing measurement provides little information about the dynamic mechanisms regulating thrombosis and microcirculation in general.Modern microcirculation research techniques, in contrast, permit direct visualization with qualitative and quantitative analysis of microcirculation in vivo.Applying these modern research techniques in model systems that simulate clinical reconstructive microsurgery has the potential to expand our understanding of the relevance of blood flow and its alterations to clinical outcomes. To enable such an understanding, this review focuses on elucidating the basic nomenclature used in microcirculation research in context of microvascular problems clinically encountered by reconstructive and trauma surgeons.

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Microcirculatory Disturbances Following the Passage of Emboli in an Experimental Free-Flap Model

Cited by 4 publications

References 0 publications

Effect of granulocytes on the microcirculation in free-flap surgery

Effect of granulocytes on the microcirculation in free-flap surgery

Die Bedeutung der Mikrozirkulation in der Plastischen Chirurgie

Microcirculation Research for Microsurgeons: Basic Concepts and Potential Applications

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