Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: Analysis of 362 free-tissue transfers

Lorenzo, Andres Rodriguez; Lin, Chih-Hung; Lin, Chih‐Hung; Lin, Yu‐Te; Nguyen, Anh Thy; Hsu, Chung-Chen; Wei, Fu‐Chan

doi:10.1016/j.bjps.2010.07.028

Cited by 81 publications

(95 citation statements)

References 24 publications

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“…Lorenzo et al 17 reported that the incidence of total flap necrosis was significantly higher in patients with 2-vein-anastomosis flaps than those with 1-vein-anastomosis flaps. Spector et al 18 stated, ''Comparing data with the group that had anastomoses distal to the zone of injury, there was no statistically significant difference in the success rate of free-tissue transfer between the proximal and distal anastomosis group.''…”

Section: Discussionmentioning

confidence: 98%

“…Our result was consistent with that of a previous report in which cases with severe bone defects had low survival rates of free grafts. 17 For these cases, a large external force was likely applied in an extensive area. Such a patient could have damaged vessels on the affected leg at sites far from the open wound.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been reported that there is no significant difference between the 2 systems when a bone flap such as a free fibula flap is used. 17,19,20 Flap selection, as well recipient vein selection, is very important. The flap selection restricts the length of vascular pedicle to a certain degree.…”

Section: Discussionmentioning

confidence: 99%

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Classification of Recipient Veins in Microsurgical Flap Reconstructions of the Lower Extremities

Kusano¹,

Kimura²,

Saito³

et al. 2012

Annals of Plastic Surgery

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It is difficult to cure severe open fractures of the lower extremities due to the frequent occurrence of severe damage to soft tissues or blood vessels, as well as bone defects, and concomitant infection, such as osteomyelitis. If appropriate treatment is not performed, long-term complications, such as nonunion of the bone, intractable ulcers, or other disorders, may arise. Between 1993 and 2010, we reviewed the records of 27 patients, and 28 limbs were treated. A total of 31 free-tissue transfers were performed on these 28 limbs. In this study, we classified the degree of damage based on the operative appearance of the condition of the recipient vein. A state that was normal or near-normal was described as type I-normal. A vein that was buried under a scar, but was comparatively easy to detach and retained a moderate adventitia was classified as type II-moderate. A vein with close adhesion between the wall and the scar that was not easy to detach was described as type III-severe. We also examined the relationships between recipient vein type and each of the following: (1) concomitant injury, (2) bone reconstruction, (3) preoperative infection, (4) length of time from injury to reconstruction, (5) eventual reoperation, and (6) flap necrosis. The results showed that there was a statistically significant relationship between recipient vein type and each of the following: bone reconstruction, preoperative infection, eventual reoperation, and flap necrosis. The selection of recipient vein is a factor that greatly affects the outcome of reconstruction of open fractures of the lower extremities. It is important to preoperatively estimate the condition of recipient vein even though it is difficult to preoperatively assess the condition. In some cases, only recipient veins in poor condition can be found intraoperatively on the affected leg. Under such circumstances, a cross-leg flap or a vein graft should be performed without hesitation to use recipient veins in a better condition.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Classification of Recipient Veins in Microsurgical Flap Reconstructions of the Lower Extremities

Kusano¹,

Kimura²,

Saito³

et al. 2012

Annals of Plastic Surgery

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“…In the setting of trauma, plastic and reconstructive surgery, soft tissue coverage is usually performed with the use of local or free skin flaps, a surgical procedure which is associated with significant morbidity due to the risk of necrosis of the implanted flap in 1-5% of cases 77,78 . This is likely to be caused by prolonged post-operative flap ischemia when the flap is exposed to during the surgery.…”

Section: Remote Ischemic Conditioning and Skin Flapsmentioning

confidence: 99%

Protection of organs other than the heart by remote ischemic conditioning

Candilio

Malik²,

Hausenloy

2013

Journal of Cardiovascular Medicine

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Organ or tissue dysfunction due to acute ischemia-reperfusion injury (IRI) is the leading cause of death and disability worldwide. Acute IRI induces cell injury and death in a wide variety of organs and tissues in a large number of different clinical settings. One novel therapeutic non-invasive intervention, capable of conferring multi-organ protection against acute IRI, is 'remote ischemic conditioning' (RIC). This describes an endogenous protective response to acute IRI, which is triggered by the application of one or more brief cycles of non-lethal ischemia and reperfusion to one particular organ or tissue. Originally discovered as a therapeutic strategy for protecting the myocardium against acute IRI, it has been subsequently demonstrated that RIC may confer protection against acute IRI in a number of different non-cardiac organs and tissues including the kidneys, lungs, liver, skin flaps, ovaries, intestine, stomach and pancreas. The discovery that RIC can be induced non-invasively by applying the RIC stimulus to the skeletal tissue of the upper or lower limb, has facilitated its application to a number of clinical settings in which organs and tissues are at high-risk of acute IRI. In this article, we review the experimental studies which have investigated RIC in organs and tissues other than the heart, and we explore the therapeutic potential of RIC in preventing organ and tissue dysfunction induced by acute IRI.

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“…7,8 Large free tissue transfers or pedicled local myocutaneous flaps are commonly troubled post-operatively with oedema of the transplanted tissue. 9 In addition to oedema, the postoperative course can be complicated by venous flap insufficiency, hematomas, hemorrhage, and infections 10,11 causing partial or total flap necrosis. Few strategies exist to mitigate flap congestion and mainly involve surgical re-exploration and application of leeches or compressive stockings, 12 but it seems the best answer is to avoid congestion if at all possible.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of a Massive Traumatic Necrotizing Wound With Contiguous Anterior Thigh and Lower Leg Fillet Flap With Leg and Hemipelvic Amputation

Frank

Hill

Clarkson

2017

Plastic Surgery Case Studies

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Reconstruction of massive soft tissue defects is challenging in the setting of polytrauma. We present a case report of a polytrauma patient with an open acetabulum fracture with a necrotizing wound that was managed with a hemipelvectomy and contiguous thigh and leg fillet flap. The harvest of the entire leg flap was utilized due to the presence of a high cervical spine injury that rendered the lower extremities non-functional. The patient's tenuous medical status was normalized once the necrotizing wound was covered, and subsequent complications related to the flap were minimized. The patient currently enjoys a reasonable quality of life consistent with that of a C7 quadriplegic.

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Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: Analysis of 362 free-tissue transfers

Cited by 81 publications

References 24 publications

Classification of Recipient Veins in Microsurgical Flap Reconstructions of the Lower Extremities

Classification of Recipient Veins in Microsurgical Flap Reconstructions of the Lower Extremities

Protection of organs other than the heart by remote ischemic conditioning

Reconstruction of a Massive Traumatic Necrotizing Wound With Contiguous Anterior Thigh and Lower Leg Fillet Flap With Leg and Hemipelvic Amputation

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