Reestablished Circulation After Free Radial Forearm Flap Transfer

Ichinose, Akihiro; Tahara, Shinya; Terashi, Hiroto; Yokoo, Satoshi

doi:10.1055/s-2004-823108

Cited by 18 publications

(6 citation statements)

References 30 publications

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“…Our results are comparable to data available in literature obtained using other technologies such as laser Doppler 8 and ultrasound Doppler. [4][5][6] For example, intraoperative decreases in blood flow after flap anastomosis 6,8 and postoperative increases/recoveries in blood flow/velocity 4,5,8 were observed, which are similar to our results (see Figs. 6 and 8).…”

Section: Discussionsupporting

confidence: 91%

“…While transcutaneous or implantable ultrasound Doppler technologies are commonly used to assess blood flow through large axial vessels, peripheral flap blood flow remains largely subjective in its clinical assessment. [4][5][6][7] A laser Doppler technique has also been used to monitor blood flow at a tiny spot of superficial tissue, [8][9][10] which may not precisely reflect hemodynamic changes in the bulk flap tissue.…”

Section: Introductionmentioning

confidence: 99%

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Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps

et al. 2015

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Knowledge of tissue blood flow (BF) changes after free tissue transfer may enable surgeons to predict the failure of flap thrombosis at an early stage. This study used our recently developed noncontact diffuse correlation spectroscopy to monitor dynamic BF changes in free flaps without getting in contact with the targeted tissue. Eight free flaps were elevated in patients with head and neck cancer; one of the flaps failed. Multiple BF measurements probing the transferred tissue were performed during and post the surgical operation. Postoperative BF values were normalized to the intraoperative baselines (assigning "1") for the calculation of relative BF change (rBF). The rBF changes over the seven successful flaps were 1.89 ± 0.15, 2.26 ± 0.13, and 2.43 ± 0.13 (mean ± standard error), respectively, on postoperative days 2, 4, and 7. These postoperative values were significantly higher than the intraoperative baseline values (p<0.001), indicating a gradual recovery of flap vascularity after the tissue transfer. By contrast, rBF changes observed from the unsuccessful flaps were 1.14 and 1.34, respectively, on postoperative days 2 and 4, indicating less flow recovery. Measurement of BF recovery after flap anastomosis holds the potential to act early to salvage ischemic flaps.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps

et al. 2015

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“…Others have found that the increase in flap pedicle blood velocity and flow is maintained long term, based on measurements obtained months after surgery. 6,22 A potential follow-up to the present study would be to verify that blood velocity differences between flaps with one venous anastomosis and flaps with two venous anastomoses persist, at least during the critical postoperative time period when the risk of thrombosis is greatest.…”

Section: Discussionmentioning

confidence: 95%

“…Ichinose et al 6 previously observed decreased vascular resistance based on blood velocity measurements using color Doppler ultrasonography after free tissue transfer and suggested multiple reasons for this. Sympathetic denervation of the flap should immediately result in vasodilation and decreased vascular resistance throughout the flap.…”

Section: Discussionmentioning

confidence: 98%

One versus Two Venous Anastomoses in Microvascular Free Flap Surgery

Hanasono

Kocak

Ogunleye

et al. 2010

Plastic and Reconstructive Surgery

107

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Background The authors’ goal was to determine whether one or two venous anastomoses results in superior blood flow through microvascular free flaps. Methods During flap harvest, blood velocity was measured in each of two venae comitantes using Doppler ultrasonography. Next, one of the two veins was occluded with a microvascular clamp and blood velocity was measured in the open vein. The clamp was then removed and placed on the other vein, and blood velocity was measured in the first vein. The pedicle was divided and microvascular anastomosis of either one or two veins was performed. Venous blood velocity was then compared between flaps with one versus two venous anastomoses. Results Eighty-one free flaps were performed. Before pedicle division, the peak venous blood velocity in each of the two venae comitantes averaged 6.3 ± 4.8 cm/second. When one of the veins was occluded, the peak venous blood velocity increased to 19.5 ± 17.3 cm/second (p <0.00001). One venous anastomosis was performed in 69 flaps and two venous anastomoses were performed in 12 flaps. The mean blood velocity in flaps in which one venous anastomosis was performed was greater than the mean blood velocity in either vein when two venous anastomoses were performed (13.1 ± 7.3 cm/second versus 7.5 ± 4.3 cm/ second, respectively; p = 0.001). Conclusions When one vena comitans is occluded, blood velocity in the second vena comitans increases significantly. Venous blood velocity is significantly greater after a single venous anastomosis than in either of two veins when two venous anastomoses are performed. These results argue against routinely performing two venous anastomoses.

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“…Hemodynamic changes such as perioperative blood flow and velocity in free tissue transfers have been researched in many ways to improve vascular patency [3][4][5][6][7][8][9][10][11]. Understanding how blood flow is reestablished, maintained, and changed after vascular anastomosis is the most basic element in free tissue transfers.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Principles in Free Tissue Transfer: Vascular Changes at the Anastomosis Site

Doh

Kim

Lee

et al. 2021

Arch Hand Microsurg

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Purpose: Various factors such as blood velocity, turbulent flow,and intimal injury are the most basic elements in free tissue transfers. However, how blood flow is reestablished, maintained, and changed after vascular anastomosis has rarely been studied.Methods: A 54-year-old male sustained an unreplantable severe crushing injury to his right hand. The middle finger was transferred to the thumb as an ectopic replantation using an anastomosis between the radial and digital arteries. However, secondary reconstruction for the first web space defect was inevitable and an anteromedial thigh free flap procedure was performed 2 months later using the previously anastomosed vessels. During the procedures, we noted morphologic changes in the microvessels and tried to explain those phenomena by applying the principles of hemodynamics.Results: Due to the discrepancy in vascular size between the radial and digital arteries, the velocity of the blood flow in the post-anastomotic site, which was the digital artery, must have been increased by Poiseuille’s law. Supposing that the velocity through the post-anastomotic site of the digital artery was increased, the pressure exerted by that flow decreased, resulting in more shrinkage of the vessel lumen of the digital artery by Bernoulli’s principle. Pascal’s law could also be applied in confined spaces with a static flow; where there is a constant pressure, as the radius of the post-anastomotic digital artery diminishes, the tension within the digital artery’s wall also simultaneously decreases. By Laplace’s law, the post-anastomotic digital artery’s wall thickens as less tension is exerted on the wall.Conclusion: Understanding these simple flow mechanics will enable microsurgeons to better avoid the risk factors causing thrombosis, which is related to flap failure.

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Reestablished Circulation After Free Radial Forearm Flap Transfer

Cited by 18 publications

References 30 publications

Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps

Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps

One versus Two Venous Anastomoses in Microvascular Free Flap Surgery

Hemodynamic Principles in Free Tissue Transfer: Vascular Changes at the Anastomosis Site

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