Abstract:
:Greater than 80 percent of free flap thromboses have been shown to occur within the first three postoperative days, warranting immediate re-exploration and restoration of adequate vessel patency. The infrequency of thromboses beyond this period is reflected in the lack of reported cases in the literature and the absence of accepted guidelines for the treatment of such delayed complications. A single study reported free flap survival in vessel thromboses only when encountered after postoperative day (POD) 7 in a pig model. Since 1990, over 800 free tissue transfers have been done at the University of Rochester. A total of ten cases of late (defined as after POD 7) arterial inflow loss were identified and examined. A retrospective chart review recorded patient demographics, site of tissue defect, free tissue transferred, major co-morbidities, preoperative XRT, timing of arterial inflow loss, nature of inflow loss, and flap survival. The mean POD of arterial inflow loss was 53 days (range: 8 to 166). The mean age of patients was 58 years. No major co-morbidities correlated with late arterial inflow loss. Loss of inflow occurred as anastomotic rupture (5), occlusion of recipient bypass graft in lower extremity cases (3), primary donor arterial thrombosis (1), and pedicle avulsion during re-exploration for seroma (1). Five flaps survived, one sustained partial necrosis, and four were completely lost. Of the five surviving flaps, three were inset into healthy recipient sites. One was utilized on a dysvascular lower extremity, and another was used in an irradiated neck defect. Of the four failed flaps, all were placed in recipient beds compromised by radiation, ischemia, or scarring. Two exemplary case reports are presented. The timing of late loss of arterial inflow does not appear to be the primary determinant of free tissue survival. The condition and quality of the recipient site plays a large role in survival of these flaps. Ischemic, irradiated, and scarred beds are inadequate in providing late flap neovascularization, compared to healthy recipient sites. When encountering late loss of arterial inflow in flaps placed on such compromised beds, the microsurgeon should not anticipate survival based on surrounding vessel ingrowth. More aggressive salvage attempts may be warranted.
journal_name
J Reconstr Microsurgjournal_title
Journal of reconstructive microsurgeryauthors
Salgado CJ,Smith A,Kim S,Higgins J,Behnam A,Herrera HR,Serletti JMdoi
10.1055/s-2002-35095subject
Has Abstractpub_date
2002-10-01 00:00:00pages
579-84issue
7eissn
0743-684Xissn
1098-8947journal_volume
18pub_type
杂志文章abstract::Two patients with scleroderma, ischemic pain, non-healing digital ulceration, and digital arterial obstruction were successfully treated with peripheral sympathectomy and digital arterial reconstruction using a reversed small-caliber vein graft. Postoperatively, digital blood flow increased and ulceration healed in bo...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2002-30181
更新日期:2002-05-01 00:00:00
abstract::This is the first report of an iatrogenic arteriovenous fistula complicating revascularization of an incomplete amputation of the hand, due to inadvertent anastomosis of the proximal radial artery to the distal cephalic vein. This resulted in a severely painful, massively swollen hand, which was initially diagnosed as...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2005-871767
更新日期:2005-07-01 00:00:00
abstract::Facial wounds are frequently associated with bone fractures and multiple trauma; however, disruption of the parotid gland or Stensen's duct is rare and is often associated with facial nerve palsy. Lesions are often undiagnosed on first assessment of the multiple trauma patient. If microsurgical repair of Stensen's duc...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1000078
更新日期:1999-02-01 00:00:00
abstract::Successful reconstruction of diabetic ulcers using free flap surgery can prevent further amputation and promote limb salvage to maintain normal gait of the patient and increase the quality of life after surgery. To minimize the postoperative complication and days of stay in hospital, surgeons should thoroughly investi...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0040-1714431
更新日期:2021-01-01 00:00:00
abstract::Functional limb salvage requires motor and sensory reconstruction of the extremity. An avulsion of the tibial nerve in the popliteal fossa after arthroscopy is presented. Functional limb recovery necessitated intraoperative nerve mapping by awake stimulation, neurotization of the gastrocnemius muscle bellies, and inte...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1006702
更新日期:1992-05-01 00:00:00
abstract::This study aimed to produce prefabricated nerve graft as effective as autologous nerve graft without donor site morbidity for repairing segmental nerve defects. Thirty rats were used and were separated into three groups. In the first group, vein graft excised from jugular vein was sutured to make a bridge between epin...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2008-1076087
更新日期:2008-02-01 00:00:00
abstract::Injury to the radial nerve is not uncommonly associated with fractures of the humerus. Despite a considerable amount of information and literature regarding management of these associated injuries, a universally accepted algorithm for treatment remains elusive. This article assimilates the data and provides evidence-b...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,评审
doi:10.1055/s-0028-1090623
更新日期:2008-11-01 00:00:00
abstract::The use of nerve conduits has evolved from a previous experimental idea to a clinical reality over the last ten years. An overview of the literature on the clinical use of nerve conduits in peripheral-nerve repair is presented. ...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,评审
doi:10.1055/s-2002-19889
更新日期:2002-02-01 00:00:00
abstract::Twenty patients with intractable diseases in the upper extremity were treated using free vascularized fibula grafts. There were 13 men and seven women. Three patients had traumatic bone defects, five had post-traumatic nonunions, two had congenital pseudoarthroses, seven had defects after tumor resection, and three ha...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1000131
更新日期:1999-10-01 00:00:00
abstract::Background To date, only a few reports have been published on idiopathic lymphedema, and most of these are case reports. In this time, we performed a retrospective review of idiopathic lymphedema patients. Methods Forty patients presented with idiopathic lymphedema that was unrelated to surgery, injury, and medical co...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0036-1586257
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND: The distal lower extremity poses unique reconstructive challenges due to its requirements for durability of the load-bearing plantar surface and for thin, pliable contour in the dorsal foot and ankle region. This study compares outcomes between muscle and fasciocutaneous flaps in patients with foot and ankl...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0039-1691785
更新日期:2019-11-01 00:00:00
abstract::Controversy surrounds the question whether free flaps remain dependent for blood supply on their vascular pedicle or if there is an autonomization by neovascularization from the surrounding wound bed. This becomes important when flap shaping or repositioning are performed. Our study involved 23 patients who received a...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0028-1103500
更新日期:2009-02-01 00:00:00
abstract::To assist nascent microsurgeons in the initial practices of handling instruments and tying knots before using an animal model, the authors discuss surgical gauze, which will be of benefit to all trainees. In this model, the nascent microsurgeon can familiarize himself or herself with the operating microscope, correct ...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2003-42634
更新日期:2003-08-01 00:00:00
abstract::We describe the novel use of a rectus abdominis myocutaneous flap for reconstruction of the female urethra following an oncological pelvic resection. Reconstruction of the female urethra from the bladder neck to external urethral orifice was successfully performed, avoiding the need for a urostomy. To our knowledge, t...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0032-1313771
更新日期:2012-07-01 00:00:00
abstract::Vascularized periosteal graft is a frequently applied flap model for bone prefabrication studies due to its inhabitance of osteoprogenitor cells and osteoinductive potential. Various bones such as rib and fibula are reported as a potential source for the harvest of the periosteal flap in experimental studies on higher...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0031-1301068
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND: Increased rates of both breast cancer and obesity have resulted in more obese women seeking breast reconstruction. Studies demonstrate that these women are at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who underwent breast reconstr...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1055/s-0038-1627449
更新日期:2018-06-01 00:00:00
abstract::The rat model is commonly utilized in peripheral nerve research. Due to the short length of the rat limb and the animal's inherent neuroregenerative capacity, the timing of assessment of nerve regeneration is critical, and significant differences between groups can be lost if assessment is done too late. Additionally,...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2001-14350
更新日期:2001-04-01 00:00:00
abstract::The preoperative identification of perforators can facilitate the appropriate design of perforator flaps from the lower extremity. Although computed tomographic arteriography can now be considered the gold standard in this regard, this technology is not universally available or inexpensive, with a nonnegligible risk f...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0029-1220860
更新日期:2009-07-01 00:00:00
abstract::Osteochondral vascularized proximal femoral allografts were orthotopically transplanted in five adult beagles (four experimental and one control). The experimental animals were placed on 0.1 mg/kg of FK506 intravenously for 7 days, and then converted to 1.0 mg/kg orally. Biopsies of the femoral heads were taken at 3 w...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2001-12701
更新日期:2001-02-01 00:00:00
abstract::Segmental defects of the distal femur following trauma pose a reconstructive challenge. A stable reconstruction capable of withstanding high forces while allowing early mobility is paramount. The Capanna technique of reconstruction combining allograft with vascularized bone graft provides such a construct and has been...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0031-1281520
更新日期:2011-07-01 00:00:00
abstract::The authors performed anastomoses of small vessels with the Nd-YAG laser, comparing these with conventional suture anastomoses. Some arteries were sutured with 10-0 nylon with about eight suture sites, and others were held by stay sutures at three points with laser irradiation performed between them. Two surgeons perf...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2000-8399
更新日期:2000-10-01 00:00:00
abstract:BACKGROUND: The use of caffeine is not recommended prior to elective microsurgery due to its demonstrated negative effects on vessel anastomosis by the presumed sympathomimetic induction of vasoconstriction. In this study, we aimed to elucidate the systemic and local effects of caffeine on vessel diameter, anastomosis ...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0038-1672130
更新日期:2019-05-01 00:00:00
abstract::Numerous investigators have attempted to enhance the survival of ischemic experimental skin flaps using various pharmacologic manipulations. Recently, the authors' laboratory demonstrated the beneficial effect of iloprost, a stable PGI2 analogue, as a post-ischemic perfusion washout, in improving the survival of ische...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1006549
更新日期:1995-09-01 00:00:00
abstract::Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent m...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,多中心研究
doi:10.1055/s-0033-1357275
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:This is a systematic review for evaluating the evidence for functional outcomes after decellularized nerve use in clinical setting. Decellularized nerves are allografts whose antigenic components have been removed, leaving only a scaffold that promotes the full regeneration of axons. METHODS:Literature rese...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1558463
更新日期:2015-11-01 00:00:00
abstract::The purpose of the present study was to analyze our long-term results of lateral calcaneal artery flap transfer for hindfoot reconstruction. A total of four patients (average age, 48 years) underwent lateral calcaneal artery flap transfer. The etiologies were heat injury of the lateral malleolus in one patient and ski...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2008-1078690
更新日期:2008-05-01 00:00:00
abstract::A continuous epidural bupivacaine infusion was used for anesthesia in 20 patients who underwent lower extremity free tissue transfer. In 60 percent of the patients, general anesthesia supplementation with nitrous oxide was used for comfort during prolonged lying on the operating table. In all cases, this technique pro...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1006939
更新日期:1988-07-01 00:00:00
abstract:BACKGROUND:Nonunions in the upper extremity are challenging for the reconstructive surgeon. The evolution of microsurgical techniques has allowed for the reliable use of free vascularized bone flaps. METHODS:In a retrospective study, patients with challenging upper limb nonunions who underwent free vascularized cortic...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0034-1390045
更新日期:2015-02-01 00:00:00
abstract::The first clinical face allotransplantation was performed by Devauchelle et al in 2005, and currently 13 facial allotransplantations have been performed worldwide. Reports on almost half of the cases were published in the literature, focusing on technical details of facial allograft inset to the recipient face. There ...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1272963
更新日期:2012-01-01 00:00:00
abstract::This paper describes a new technique for microvascular anastomosis, which involves the overlapping of the adventitias of the two ends of a severed blood vessel, and then painting a cyanoacrylate adhesive on the outer surface of the vessel around the anastomosed part. Sixteen anastomoses were performed in both radial a...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2004-824890
更新日期:2004-05-01 00:00:00