Replantation of a large amputated segment of the face: A new technique

Abstract

A microvascular replantation of an amputated large facial segment, using a segment of the descending branch of the lateral circumflex femoral artery and its venae comitantes instead of interpositional vein grafts, is presented, and the advantages of this procedure are discussed.Q 1995 Wiley-Liss, Inc. MICROSURGERY 16:594-597 1995Replantation of amputated segments of the face is a challenging problem. Although the best cosmetic and functional results are obtained with replantation of severed tissue using microsurgical arterial and venous anastomoses, only a few successful cases have been reported so far.'p6 This is due mainly to the small size of the vessels to be anastomosed. We report a case of successful replantation of a completely amputated large facial segment using the vascular tree of the descending branch of the lateral circumflex femoral artery and its venae comitantes instead of interpositional vein grafts. CASE REPORTA 79-year-old man sustained a complete amputation of the whole nose, upper lip, and cheek skin when the blade of a grass cutting machine hit a rock on the ground and rebounded on his face. He was immediately transferred to the hospital, together with the amputated facial segment. The piece measured approximately 10 x 8 cm and was composed of the entire nose, full thickness of the upper lip, and the skin of the right cheek. The septa1 cartilage and part of the nasal bone were also included in the segment, as well as the vestibular skin and the mucous membrane (Figs. 1, 2 ) . After hemostasis of the facial wound was achieved, replantation of the amputated facial segment was attempted by a young plastic surgeon who is unfamiliar with microsurgery. Six hours after injury, the superior labial artery was anas- tomosed and the segment turned pink in color. However, veins suitable for anastomosis could not be found in the segment and complete obstruction of the arterial anastomosis developed soon after. Surgery was stopped then to evaluate the patient's general condition and the plastic surgeon asked our department for help.On our arrival, 11 hr after injury, replantation was started again with the consent of the patient's family. During the induction of general anesthesia, bench microdissection of the segment was performed to identify vessels suitable for anastomosis. The segment was irrigated with saline solution containing heparin and urokinase through the superior labial artery (1.0 mm in diameter), located at the right lateral aspect of the upper lip, and two veins, which were believed to be the right and left angular veins (0.6 to 0.8 mm in diameter), were identified at the root of the nose. The ischemic time was more than 12 hr. Therefore, arterial inflow was established first by anastomosing the superior labial artery of the amputated segment to the descending branch of the lateral circumflex femoral artery. After releasing the vascular clamp, the segment immediately turned pink and brisk bleeding from the edge was noted. Subsequently, venous anastomoses were performed between the two angu...

Exploring the Possibility of a Retrograde Embolism Pathway from the Facial Artery to the Ophthalmic Artery System In Vivo

“…Considering operational attention, previous scholars have suggested using blunt cannulas, sngiotonica, or a low injection pressure [8,[21][22][23][24]. In these preventive measures, the use of blunt cannulas and sngiotonica aims to prevent the needle from entering or damaging the blood vessels.…”

Usefulness of vascular bundle interposition of the descending branch of the lateral circumflex femoral vessels for free flap reconstruction of the calvarial defect

“…Vascular bundle interposition graft using the descending branch of the lateral circumflex femoral artery and its venae comitantes was first reported in replantation of large amputated segment of face with successful result in 1995. 9 Reliability of arterial graft of this vascular bundle has been also proved as a cardiac bypass graft material substituted to conventional great saphenous vein graft, 10,11 and as an extra-intracranial bypass graft in neurosurgery. 12 In this case report, the vascular bundle interposition graft of the descending branch of the lateral circumflex femoral artery and its venae comitantes was successfully used for free flap coverage of the large calvarial defect with no recipient vessel for direct anastomosis.…”