The Effect on Venous Congestion of Diverting Arterial Flow in the Arterialized Venous Flap

Reconstruction of digital defects using the venous flap offer several advantages but remained unpopular owing to levels of venous congestion rates. We performed animal studies to test the hypothesis that an arterio-venous shunt increases pressure for peripheral flap perfusion and decreases venous congestion. Using an abdominal adipofascial flap model in six male Sprague–Dawley rats, microcirculation was modified as follows: type I – arterial flap; type II – flow-through arterio-venous flap (AVF); and type III – shunt-restricted AVF. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type II flaps, blood flow oscillated without a dominant direction and came to a standstill. In type III flaps, blood flowed proximally in a reverse direction whereas distally, flow was similar to type I flaps. In a clinical series, 21 patients received a total of 22 shunt-restricted AVFs. All 22 clinical flaps survived; four flaps suffered epidermolysis but recovered without full thickness loss.

Download Full-text

One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

Plastic Surgery ◽

10.1177/2292550317740693 ◽

2017 ◽

Vol 26 (2) ◽

pp. 91-98

Author(s):

Jennifer L. K. Matthews ◽

Noor Alolabi ◽

Forough Farrokhyar ◽

Sophocles H. Voineskos

Keyword(s):

Systematic Review ◽

Free Flap ◽

Meta Analysis ◽

Venous Congestion ◽

Flap Surgery ◽

Flap Failure ◽

Free Flap Surgery ◽

Significant Difference ◽

Reoperation Rates ◽

Venous Flap

Background: The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems. Methods: A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs). Results: Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27). Conclusions: There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.

Download Full-text

The position of ‘shunt restriction’ along an arterialized vein affects venous congestion and flap perfusion of an arterialized venous flap

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2016.05.013 ◽

2016 ◽

Vol 69 (10) ◽

pp. 1389-1396 ◽

Cited By ~ 1

Author(s):

Yu-Te Lin ◽

Chung-Cheng Hsu ◽

Cheng-Hung Lin ◽

Charles Yuen Yung Loh ◽

Chih-Hung Lin

Keyword(s):

Venous Congestion ◽

Venous Flap ◽

Flap Perfusion

Download Full-text

Importance of venous congestion for worsening of renal function in advanced decompensated heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60409-9 ◽

2008 ◽

Vol 7 ◽

pp. 144-144

Author(s):

W MULLENS ◽

Z ABRAHAMS ◽

G FRANCIS ◽

G SOKOS ◽

D TAYLOR ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Decompensated Heart Failure ◽

Venous Congestion

Download Full-text

Does mesh/perimesh fibrosis have an effect on testicular arterial flow in patients with repaired inguinal hernia?

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2007-988956 ◽

2007 ◽

Vol 28 (S 1) ◽

Cited By ~ 1

Author(s):

S Uysal Ramadan ◽

D Gokharman ◽

I Tuncbilek ◽

H Ozer ◽

P Kosar ◽

...

Keyword(s):

Inguinal Hernia ◽

Arterial Flow

Download Full-text

A rare anastomosis between the root of common hepatic artery and proper hepatic artery: implications for pancreaticoduodenectomy

Surgical Case Reports ◽

10.1186/s40792-019-0746-y ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 1

Author(s):

Takeshi Morinaga ◽

Katsunori Imai ◽

Keisuke Morita ◽

Kenichiro Yamamoto ◽

Satoshi Ikeshima ◽

...

Keyword(s):

Pancreatic Cancer ◽

Hepatic Artery ◽

Pancreatic Head ◽

Common Hepatic Artery ◽

Arterial Flow ◽

Anastomotic Site ◽

Proper Hepatic Artery ◽

Arterial Reconstruction ◽

Hepatic Arterial Flow ◽

The Common

Abstract Background Hepatic artery anomalies are often observed, and the variations are wide-ranging. We herein report a case of pancreatic cancer involving the common hepatic artery (CHA) that was successfully treated with pancreaticoduodenectomy (PD) without arterial reconstruction, thanks to anastomosis between the root of CHA and proper hepatic artery (PHA), which is a very rare anastomotic site. Case presentation A 78-year-old woman was referred to our department for the examination of a tumor in the pancreatic head. Contrast-enhanced computed tomography (CT) revealed a low-density tumor of 40 mm in diameter located in the pancreatic head. The involvement of the common hepatic artery (CHA), the root of the gastroduodenal artery (GDA), and portal vein was noted. Although such cases would usually require PD with arterial reconstruction of the CHA, it was thought that the hepatic arterial flow would be preserved by the anastomotic site between the root of the CHA and the PHA, even if the CHA was dissected without arterial reconstruction. PD with dissection of the CHA and PHA was safely completed without arterial reconstruction, and sufficient hepatic arterial flow was preserved through the anastomotic site between the CHA and PHA. Conclusion We presented an extremely rare case of an anastomosis between the CHA and PHA in a patient with pancreatic cancer involving the CHA. Thanks to this anastomosis, surgical resection was successfully performed with sufficient hepatic arterial flow without arterial reconstruction.

Download Full-text