Descending Geniculate Artery: The Ideal Recipient Vessel for Free Tissue Transfer Coverage of Below-the-Knee Amputation Wounds

2011 ◽  
Vol 27 (09) ◽  
pp. 525-530 ◽  
Author(s):  
James Higgins
Keyword(s):  
Free Tissue Transfer ◽  
Recipient Vessel ◽  
Knee Amputation ◽  
Below The Knee ◽  
Tissue Transfer ◽  
The Ideal

Anatomic Considerations of Microvascular Free Tissue Transfer in Endoscopic Endonasal Skull Base Surgery

2021 ◽  
Author(s):  
Leila J. Mady ◽  
Thomas M. Kaffenberger ◽  
Khalil Baddour ◽  
Katie Melder ◽  
Neal R. Godse ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Free Tissue Transfer ◽  
Level Of Evidence ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Recipient Vessel ◽  
Tissue Transfer ◽  
Anterior Cranial Base ◽  
Pedicle Length

Abstract Objective Though microvascular free tissue transfer is well established for open skull base reconstruction, normative data regarding flap design and inset after endoscopic endonasal skull base surgery (ESBS) is lacking. We aim to describe anatomical considerations of endoscopic endonasal inset of free tissue transfer of transclival (TC) and anterior cranial base resection (ACBR) defects. Design and Setting Radial forearm free tissue transfer (RFFTT) model. Participants Six cadaveric specimens. Main Outcome Measures Pedicle orientation, pedicle length, and recipient vessel intraluminal diameter. Results TC and ACBR defects averaged 17.2 and 11.7 cm2, respectively. Anterior and lateral maxillotomies and endoscopic medial maxillectomies were prepared as corridors for flap and pedicle passage. Premasseteric space tunnels were created for pedicle tunneling to recipient facial vessels. For TC defects, the RFFTT pedicle was oriented cranially with the flap placed against the clival defect (mean pedicle length 13.1 ± 0.6 cm). For ACBR defects, the RFFTT pedicle was examined in three orientations with respect to anterior–posterior axis of the RFFTT: anteriorly, posteriorly, and laterally. Lateral orientation offered the shortest average pedicle length required for anastomosis in the neck (11.6 ± 1.29 cm), followed by posterior (13.4 ± 0.7cm) and anterior orientations (14.4 ± 1.1cm) (p < 0.00001, analysis of variance). Conclusions In ACBR reconstruction using RFFTT, our data suggests lateral pedicle orientation shortens the length required to safely anastomose facial vessels and protects the frontal sinus outflow anteriorly while limiting pedicle exposure through a maxillary corridor within the nasal cavity. With greater understanding of anatomical factors related to successful preoperative flap planning, free tissue transfer may be added to the ESBS reconstruction ladder. Level of Evidence NA

Geometric Three-Dimensional End-to-Side Microvascular Anastomosis: A Simple and Reproducible Technique

2017 ◽  
Vol 34 (04) ◽  
pp. 258-263 ◽  
Author(s):  
Adrian Ooi ◽  
Daniel Butz ◽  
Sean Fisher ◽  
Zachary Collier ◽  
Lawrence Gottlieb
Keyword(s):  
Three Dimensional ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Suture Line ◽  
Success Rates ◽  
Recipient Vessel ◽  
Wide Range ◽  
Extremity Reconstruction ◽  
Geometric Technique ◽  
The Ideal

Background End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is critical. The ideal ETS microanastomosis should maintain a wide aperture and have a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity of the suture line. We have developed a unique, dependable, and reproducible geometric technique for ETS anastomoses, and analyze its efficacy in our series of patients. Methods The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped defect on the recipient vessel wall, followed by a slit incision of the donor vessel to create a “spatula” fitting this defect. This technique removes sutures from the point of most turbulent blood flow while holding the recipient vessel open with a patch vesselplasty effect. We perform a retrospective review of a single surgeon's experience using this technique. Results The geometric 3D ETS technique was used in 87 free flaps with a total of 102 ETS anastomoses in a wide range of cases including head and neck, trunk and genitourinary, and extremity reconstruction. Overall, free flap success rates were 98%. Conclusions The geometric 3D ETS technique creates a wide anastomosis, minimizes turbulence-inducing thrombogenicity, and mechanically holds the recipient vessel open. It is reliable and reproducible, and when performed properly has been shown to have high rates of success in a large group of free tissue transfer patients.

Vasopressor-Dependent Recipient Vessel Blood Flow in Head and Neck Free Tissue Transfer: A Report of Two Cases

2015 ◽  
Vol 31 (06) ◽  
pp. 477-480
Author(s):  
Edward Swanson ◽  
Srinivas Susarla ◽  
Georgia Yalanis ◽  
Hsu-Tang Cheng ◽  
Denver Lough ◽  
...  
Keyword(s):  
Blood Flow ◽  
Head And Neck ◽  
Free Tissue Transfer ◽  
Recipient Vessel ◽  
Tissue Transfer

Usability of the Middle Temporal Vein as a Recipient Vessel for Free Tissue Transfer in Skull-Base Reconstruction

2012 ◽  
Vol 68 (3) ◽  
pp. 286-289 ◽  
Author(s):  
Tomoyuki Yano ◽  
Kentarou Tanaka ◽  
Hideo Iida ◽  
Seiji Kishimoto ◽  
Mutsumi Okazaki
Keyword(s):  
Skull Base ◽  
Free Tissue Transfer ◽  
Skull Base Reconstruction ◽  
Middle Temporal ◽  
Recipient Vessel ◽  
Tissue Transfer

scholarly journals Creation of Superficial Temporal Arteriovenous Loop for Staged Free Tissue Transfer for Dural Coverage in the Setting of Radiation: A Case Report

2020 ◽  
Vol 5 ◽  
pp. 247275122097809
Author(s):  
Pallavi A. Kumbla ◽  
René P. Myers
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Elderly Male ◽  
Large Defect ◽  
Vein Grafts ◽  
Recipient Vessel ◽  
Tissue Transfer ◽  
Increased Risk ◽  
Arteriovenous Loop ◽  
Superficial Temporal Vessels

Free tissue transfer for dural coverage can be challenging for various reasons. In the case of malignancy, patients often have received significant doses of radiation to the head and neck leading to fibrosis and osteoradionecrosis. Not only will free tissue transfer need to accommodate an often large defect but will need to protect intracranial contents. Recipient vessel quality and patency is often affected by comorbidities such as diabetes mellitus and coronary artery disease and can be compounded by radiation. Due to these factors, more proximal vessels in the head and neck are often pursued but due to insufficient length, often require vein grafts or arteriovenous loops to reach the donor vessels for anastomosis. This requires larger incisions and harvesting of lengthy veins. In this study, we discuss a technique of harvesting a small dorsal hand vein, that is hidden well in a hand crease, to create an arteriovenous loop between the superficial temporal vessels. Benefits include exploration of the recipient superficial temporal vessels prior to craniectomy without creating additional incisions, readily accessible recipient vessels to reach donor vessels without harvesting lengthy vein grafts, and allowing for arterialization of the superficial temporal vein leading to decreased venous congestion and thrombosis. While this can be done in 1 stage, we perform this in 2 stages to avoid an increased number of anastomoses and increased risk of flap failure. We present the case of an elderly male with multiple comorbidities and scalp osteoradionecrosis secondary to malignancy who this technique was successfully performed on.

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