Retrograde arterialized venous flap: An experimental study

Moshammer, Harald; Schwarzl, F.; Haas, F.; Maechler, H.; Pierer, Gerhard; Wiltgen, M.; Koch, Horst

doi:10.1002/micr.10108

Cited by 37 publications

(39 citation statements)

References 36 publications

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“…An experimental study with venous flaps from cadaver specimens indicated that the perfusion of the periphery of a venous flap can be enhanced by retrograde arterialization. 25 To date, there is little clinical literature on this. In contrast, Inoue and Tamura attributed one complete flap loss in a clinical series to retrograde flow due to a planning mistake, 8 and Nakayama et al stated that blood flow against the valves was a hazard to flap circulation.…”

Section: 4611à1315à18mentioning

confidence: 96%

“…In contrast to references stating that retrograde perfusion, i.e., perfusion against the venous valves in the flap, would represent a hazard to flap circulation, 7,8 an experimental study with flaps from human cadavers indicated that blood circulation in the periphery of arterialized venous flaps can be enhanced by retrograde arterialization. 25 Based on the results of this study, retrograde AVFs were applied in 13 patients with skin and soft-tissue defects.…”

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confidence: 99%

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Clinical application of the retrograde arterialized venous flap

et al. 2004

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Retrograde arterialized venous flaps were applied to skin and soft-tissue defects in 13 patients with an average age of 34.4 years. Ten defects were located on the hand, and three on the lower leg. All flaps were harvested from the flexor aspect of the forearm; they ranged in size from 2 x 1 to 11 x 7 cm. There was venous congestion with superficial epidermolysis in six flaps, but not in the other seven. Partial skin necrosis in two of the lower-extremity flaps necessitated secondary skin grafts. Our results suggest that retrograde perfusion enhances blood flow in the periphery of arterialized venous flaps and gives good results in terms of flap survival, especially on the upper extremity.

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Section: 4611à1315à18mentioning

confidence: 96%

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confidence: 99%

Clinical application of the retrograde arterialized venous flap

et al. 2004

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“…This can result in insufficient perfusion of the flap's periphery and hence partial necrosis. Moshammer et al 16 suggested perfusing an AVF retrogradely to increase flow in the peripheral of the flap in a single-stage procedure. They hypothesized that the valves in the veins will produce resistance to flow and force blood toward the vessels in the flap's periphery.…”

Section: Discussionmentioning

confidence: 99%

“…This will therefore decrease marginal necrosis and increase flap survival. Moshammer et al 16 showed in his experiments on venous flaps from human cadavers that the blood circulation in the periphery of AVFs may be enhanced by retrograde arterialization. A clinical study by Koch et al 17 showed that a 100% success rate may be achieved with retrograde arterialized venous flaps (RAVFs) used in the upper extremity, however, this was not compared with AVFs used in similar situations.…”

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confidence: 98%

A novel rabbit model for the evaluation of retrograde flow venous flaps

2009

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Venous flaps have several potential advantages over traditional flaps, but their uses have been limited by unpredictable survival. Although clinical and experimental studies have concentrated mainly on the antegrade arterialization of venous flaps to increase survival, retrogradely arterialized venous flaps (AVFs) may have the greatest potential. There is, however, little literature on their use. There are also no animal studies comparing their survival to other venous flaps used in a similar situation. Our aim was to design a flap utilizing the rabbit's valved, thoracoepigastric vein (consisting of the lateral thoracic and epigastric veins) as the source vessel for the study of retrograde arterialized venous flaps (RAVFs). A pilot study (n = 10) to determine the survival of RAVFs was performed utilizing this animal model. Four flaps had complete survival at the end of our 2-week observational period. However, we also had four partial flap losses and two cases in which the entire flap was lost. An average survival area of 44.5% was observed. In conclusion, our designed rabbit thoracoepigastric RAVF is simple to apply and easily reproducible. It is the first animal flap adapted specifically for the study of RAVFs, and may be used for the further investigation of these flaps, which have shown unpredictable survival to date.

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“…This not only prevents the valves impeding on blood flow but also can be used to create the necessary pressure to divert blood to the periphery of the flap. 2,45,46 Of note, however, is that valves can become incompetent with sustained arterial pressure and with time, veins can also become incompetent when denervated. 25,47 The second element is that the flaps must contain a rich venous network for both the afferent and efferent veins.…”

Section: Casementioning

confidence: 96%