Rapid autonomisation of a combined fibular‐ and anterolateral thigh flap transferred by a wrist carrier to an irradiated and vessel depleted neck

Wolff, Klaus‐Dietrich; Mücke, Thomas; Lehmbrock, Jutta; Loeffelbein, Denys J.; Kesting, Marco; Hölzle, Frank

doi:10.1002/jso.21205

Cited by 20 publications

(17 citation statements)

References 31 publications

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“…On the other hand, clinical reports describe complete flap survival despite early disruption of the pedicle (Chen et al, 2002;Salgado et al, 2002;Wolff et al, 2003Wolff et al, , 2009Wise et al, 2011); this has also been shown in experimental work (Civelek et al, 2009;Mucke et al, 2011). In all three patients, 10e13 days of extracorporeal perfusion were sufficient for bone and muscle tissue, but not for the large skin paddle in patient 1.…”

Section: Discussionsupporting

confidence: 54%

“…Repetitive occlusion of the vascular bridge was performed to induce gradually increasing ischemic periods. By doing so, flap autonomisation occurred as early as day 16 and 18, respectively (Wolff et al, 2003(Wolff et al, , 2009. Other clinical reports have described a complete survival of free flaps after an inadvertent early disruption of the blood supply between days 7 and 17 (Chen et al, 2002;Wise et al, 2011), but not in irradiated defects (Salgado et al, 2002).…”

Section: Introductionmentioning

confidence: 96%

“…However, vein grafts or vascular loops are necessary to provide a pedicle long enough for tensionless anastomosis (Urken et al, 2006;Ethunandan et al, 2007;Aycock et al, 2008;Quilichini et al, 2012;Roche et al, 2012;Karle et al, 2013), significantly increasing the risk for flap loss (Bozikov and Arnez, 2006). For these patients, we described a temporary perfusion of composite fibular flaps by anastomosing the flaps to the radial vessels ("carrier flap") with long-term fixation of the arm in an elevated position (Wolff et al, 2003(Wolff et al, , 2009. Repetitive occlusion of the vascular bridge was performed to induce gradually increasing ischemic periods.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Wolff

Mücke

Bomhard

et al. 2016

Journal of Cranio-Maxillofacial Surgery

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Wolff

Mücke

Bomhard

et al. 2016

Journal of Cranio-Maxillofacial Surgery

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“…Although these findings support the importance of an intact vascular pedicle for permanent flap survival, especially in irradiated recipient sites, other reports document early autonomization which became evident after division of the pedicle during the first days after surgery 11, 12, 17–20. According to these well‐documented clinical cases, neovascularization seems to be capable of sustaining the flap from about 5 days post surgery.…”

Section: Discussionmentioning

confidence: 68%

“…Autonomization of free flaps was defined as stable HbO 2 and CF during the performed O2C measurements. According to the literature, values of HbO 2 above 20 AU and CF above 20 AU after at least 1 min of pedicle compression was defined as autonomized 9–11. Measurements below these values were defined as not autonomized flaps, and all of these flaps showed values of HbO 2 developing to 0–5 AU after about 2 min.…”

Section: Resultsmentioning

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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Autonomization of epigastric flaps in rats

et al. 2011

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The question of how long a flap depends on its pedicle cannot be answered clearly from the available literature. To address this, we investigated the time to flap autonomization in the wound bed and the length of time to the point when flap necrosis is reduced to a clinically negligible level. The superficial epigastric flap was raised in 24 rats. After 3, 5, 7, or 10 days of wound healing, the pedicle was again exposed, ligated, and divided. Values of blood flow (flow), velocity (velocity), hemoglobin level (Hb), and oxygen saturation (SO(2) ) were noninvasively measured using Laser spectrophotometry. The area of necrosis of the flap was 62.77 ± 1.71% after 3 days, 16.26 ± 0.86% after 5 days, 2.88 ± 0.14% after 7 days, and 1.64 ± 0.16% after 10 days (P < 0.001). Hb, flow, and velocity were found to be significant factors on developing flap necrosis at the preoperative and postoperative time point (P < 0.0001), whereas SO(2) and flow were significant predictors of necrosis at the time of pedicle ligation (P < 0.0001). The percentage changes of SO(2) (P < 0.0001), flow (P < 0.0001), and velocity (P = 0.001) between the different time points were significant predictors of flap necrosis. The time needed for the complete autonomization of vascularized free flaps in their wound beds has been found as completed between the 5th and 7th day postoperatively in this rat model. The area of flap necrosis depends on the present value of SO(2) , Hb, flow, and velocity at different time points, but, more importantly, also on the perioperative change of these parameters.

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Rapid autonomisation of a combined fibular‐ and anterolateral thigh flap transferred by a wrist carrier to an irradiated and vessel depleted neck

Cited by 20 publications

References 31 publications

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

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

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

Autonomization of epigastric flaps in rats

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