Wound closure by means of free flap and arteriovenous loop: Development of flap autonomy in the long‐term follow‐up

Abstract

Free flaps in combination with arterial reconstruction by means of arteriovenous loops or bypass have, meanwhile, been established as a therapeutic option in defect reconstruction for areas without recipient vessels. Our aim was to analyse the long-term performance, flap autonomy, and the flap perfusion. Patients receiving this combined reconstruction at a single-centre institution were included. During follow-up examination, the patency of arterial reconstruction was investigated by duplex ultrasound. Flap micro-circulation was assessed by laser Doppler flowmetry and white light tissue spectrometry (O2C) as well as by indocyanine green fluorescence angiography. Twentythree patients could be clinically followed up. Duplex ultrasound showed, in four cases, arterial pedicle occlusion in spite of vital flap. Comparison of the O2C perfusion parameters between flaps with occluded pedicles and those with intact inflow showed no significant difference (parameters sO2: P = .82; Flow: P = .31). Similar results were obtained by fluorescence angiography; no significant difference could be detected between both groups (parameters Ingress P = .13; Ingressrate P = .54). Combined vascular reconstruction with free tissue transfer is associated with a good long-term outcome and wound closure. Even after flap transplantation to areas with critical tissue perfusion, the flap can develop autonomy and thus survive after pedicle occlusion.

Novel imaging methods reveal positive impact of topical negative pressure application on tissue perfusion in an in vivo skin model

“…5 In spite of huge clinical experience and clinical research mainly based on case series and clinical trials, the exact underlying mechanisms are still not fully understood. 2 , 5 , 6 , 7 , 8 , 9 , 10 The influence of TNPA on the perfusion of a wound and the flow of adjacent vessels and capillaries is part of an ongoing controversial discussion. Many experimental and clinical studies indicate an increase of blood flow across the wound and/or close to the wound margins.…”

Perfusion Parameters in Near-Infrared Fluorescence Imaging with Indocyanine Green: A Systematic Review of the Literature

“…Fluorescent imaging was quantitatively reported in 15 articles, including 515 patients [ 6 , 7 , 10 , 13 , 17 , 19 , 22 , 23 , 36 , 37 , 46 , 51 , 52 , 53 , 57 ]. The fields of application included free-flap and DIEP flap perfusion, breast reconstruction surgery, and microvascular surgery.…”

“…Inflow and outflow parameters were mentioned in seven ( n = 128) free-flap and DIEP flap studies [ 10 , 13 , 23 , 36 , 37 , 52 , 53 ]. Two studies describe no significant differences in the ingress and ingress rate [ 10 , 13 ]. Significant differences in inflow parameters including the slope, Tmax, PDE10, slope at T1/2, and T1/2 were seen in three studies [ 23 , 37 , 53 ].…”

Limb salvage procedure in immunocompromised patients with therapy‐resistant leg ulcers—The value of ultra‐radical debridement and instillation negative‐pressure wound therapy

“…Despite the common consensus of limb preservation if any possible, about 45 000 limb amputations are inevitably performed as a result of non‐healing chronic wounds in Germany each year 16 . Various reconstructive wound closure methods with different levels of complexity such as skin grafting, local flaps, and free tissue transfer often remain the only way to save the affected limb from an amputation 42,43 . Wound size, location, and severity as well as the general health condition determines the choice of the reconstructive surgery procedure for each individual patient.…”

“…16 Various reconstructive wound closure methods with different levels of complexity such as skin grafting, local flaps, and free tissue transfer often remain the only way to save the affected limb from an amputation. 42,43 Wound size, location, and severity as well as the general health condition determines the choice of the reconstructive surgery procedure for each individual patient. Surgical debridement and NPWT are wellestablished tools for wound bed preparation prior to definite wound closure.…”