Timing of Pedicle Thrombosis and Flap Loss after Free-Tissue Transfer

Kroll, Stephen S.; Schusterman, Mark A.; Reece, Gregory P.; Miller, Michael J.; Evans, Gregory R. D.; Robb, Geoffrey L.; Baldwin, Bonnie J.

doi:10.1097/00006534-199612000-00017

Cited by 402 publications

(383 citation statements)

References 4 publications

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“…This delay is two hours for arterial thrombosis and about 4 hours for venous thrombosis. Other studies are in agreement with our results [5,6]. The value of intracapillary glucose and lactate and their respective kinetics allow early suspicion of arterial thrombosis.…”

Section: Discussionsupporting

confidence: 92%

“…These complications often occur in the first twenty-four hours [1,5,[12][13][14]. This acute period does not allow the creation of a microvascular network, unlike what happens in chronic occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…There are multiple causes: infection, dehiscence of sutures, compression or vascular thrombosis. Vascular thrombosis are the most frequent complications and represent 15-73% [3][4][5]. The majority of these complications occurred within the first 24 postoperative hours.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Garcı́a-Dorado¹,

Moris²,

Cristofari³

et al. 2017

clinical-practice

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“…Venous thrombosis is more than twice as common as arterial thrombosis among causes of flap failures due to pedicle thrombosis. (6) Compression due to hematoma was the cause for vascular compromise and impending flap failure in our subject. Hidalgo et al (4) identified venous problems (35%) as the most common etiology of flap failure followed by arterial problems (28%), hematoma (26%) and recipient vessel problems (11%).…”

Section: Discussionmentioning

confidence: 76%

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

2016

IJASHNB

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The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in Maxillofacial reconstruction. Although associated complications are inevitable in a percentage of patients, it is good postoperative care and monitoring that determines the success or failure of the reconstruction. With early recognition and prompt intervention salvage of compromised flap is possible. The purpose of this article is to emphasise the importance of keeping low threshold for re-exploration in situation of any suspected failing free flap. Pt ReportA 60 year-old male patient presented with an ulcero-proliferative mass measuring around 4cmx3.5 cm which involved the right lip mucosa and had infiltrated the underlying tissue to appear over the skin with central zone of necrosis and surrounding erythematous induration. (Fig. 1) Incisional biopsy from mucosal surface of the lesion revealed well to moderately differentiated squamous cell carcinoma. The neck was clinically N0 which similarly correlated following contrast CT scan of the neck. The surgical planning for the tumour was wide excision, SOND (Supra Omohyoid neck dissection) and reconstruction of the defect with FRAFF. Wide excision of the primary lesion was carried out along with the SOND on the affected side.The neck dissection was done with extreme care to preserve the facial vessels when dissecting level IB. Dissection of the submandibular gland was done by safely ligating the submandibular branches of the facial artery to the gland and preserving the whole artery along its course on the posterior aspect of the gland. The right lip commissure involving lateral one third of the lower lip, part of skin in the cheek along with underlying part of cheek musculature, inner buccal and labial mucosa, gingivo-buccal sulcus and gingiva along with the alveolar bone sparing the lower border of the mandible were resected. The size of the primary defect following tumour resection was 5.2x4.8x3.7 cm. The reconstruction of the surgical defect was done with FRAFF. On completion of the reconstruction the flap looked well perfused and healthy. The flap was monitored clinically at an hourly basis. By 4 th -5 th hours mild ooze from the drain port had become noticeable along with marked oedema in the flap. (Fig. 2) On the 8 th hour post operatively there was dusky appearance of the flap, along with oedema. On needle prick there was dark blood ooze from the flap and therefore the decision for re exploration was taken suspecting venous compromise. On re exploration a huge hematoma was noticed under the flap, around the anastomosis and along the IJV. The clots were delicately removed. The adjoining areas were irrigated with warm saline, and venous and arterial anastomoses were evaluated. There were no clots in the vein and normal flow through the artery was seen. Acland's "milking" test was performed. In the test the artery was occluded with a forceps immediately caudal to anastomosis and then with a second forceps artery was occl...

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“…Certain surgeons have hypothesized that performing two venous anastomoses (AV and SV) is imperative for the survival of flow-through flap grafts because multiple draining veins result in improved blood flow through the flap (31,32). Hanasono et al (33) considered that the blood velocity of a flap graft with two venous anastomoses did not increase significantly and resulted in a better prognosis when compared with one venous anastomosis (AV) in patients who underwent a flap graft with one or two anastomoses, due to the hypothesis that thrombosis is associated with a low-velocity state and performing two anastomoses theoretically increased the risk of thrombosis.…”

Section: A D C B E Discussionmentioning

confidence: 99%

Effects of preserving different veins on flow-through flap survival: An experimental study

Song

2015

Experimental and Therapeutic Medicine

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Abstract. Flow-through skin flap grafting is becoming widely used for the reconstruction of skin and soft tissue defects, particularly for patients with poor blood supply around the defect. However, the treatment of the veins remains controversial. In the present study, 5x2-cm skin flaps were created on the left inner thighs of rabbits in order to investigate the effects of various treatments of the veins on the survival of a flow-through skin flap. A femoral artery perforator running through the flap was preserved. Five groups were established in which no veins, one superficial vein (SV), one accompanying vein (AV), one SV plus one AV, or all trunk veins (control) were retained. The percentage of flap area survival was determined on day 10. On days 3, 5, 7 and 9, tissues were harvested from the skin flaps and immunohistochemical analysis was performed in order to count the number of microvessels. Western blot analysis was subsequently completed in order to determine the expression levels of vascular endothelial growth factor (VEGF). The flap areas in which no veins were retained demonstrated significantly reduced survival rates on day 10, as compared with those in the other four groups (P<0.01). Furthermore, flaps with the retention of a SV also demonstrated reduced survival rates, as compared with the AV, AV plus SV and all veins groups (P<0.01); however, there no significant differences were detected between the latter three groups (P>0.05). Immunohistochemical analysis on day 3 detected a greater number of microvessels in the flaps of the control group, as compared with the flaps of the other groups. Furthermore, the AV and AV plus SV groups demonstrated a greater number of microvessels, as compared with the SV and no vein groups, and he no vein group demonstrated the fewest microvessels. No significant differences were found between the AV, AV plus SV and control groups on day 5, 7 and 9. Western blot analysis on day 5 demonstrated that the expression levles of VEGF were significantly increased in the flaps of the AV, AV plus SV and control groups, as compared with those in the SV and no vein groups. No significant differences were detected between the former three groups, and increased VEGF expression levels were detected in the flaps of the SV group, as compared with the no vein group. The flow-through flap grafts with no retained veins barely survived. Anastomosing one AV was adequate for flap survival; however, further studies are required in order to investigate the survival of flow-through flaps in more detail.

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Timing of Pedicle Thrombosis and Flap Loss after Free-Tissue Transfer

Cited by 402 publications

References 4 publications

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Monitoring of myocutaneous flaps by intracapillary glucose and lactate measurements: experimental study

Salvage of free radial artery forearm flap following reconstruction of lower lateral lip: A case report

Effects of preserving different veins on flow-through flap survival: An experimental study

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