scholarly journals Focused Arterial Anastomotic Assessment in a Novel Univariate Design of a Vertical Rectus Abdominis Muscle Flap in a Pig Model

2017 ◽  
Vol 02 (01) ◽  
pp. e52-e57
Author(s):  
Claudia Fischlin ◽  
Zacharia Mbaidjol ◽  
Radu Olariu ◽  
Mihai Constantinescu ◽  
Jonathan Leckenby
Keyword(s):  
Muscle Flap ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Laser Doppler ◽  
Flow Measurements ◽  
Tissue Transfer ◽  
Free Flap Transfer ◽  
Vram Flap ◽  
Arterial Anastomosis ◽  
The Right

Background Microsurgical anastomosis is the basis for free tissue transfer. The goal of this study was to create an animal model that mimics free tissue transfer but would focus on the arterial anastomotic assessment alone, without additional bias of a venous anastomosis. Methods A vertical rectus abdominis musculocutaneous (VRAM) flap based on the left deep superior epigastric artery (DSEA) was raised in six large white pigs. The right DSEA was raised and used as the donor vessel. An arterial end-to-end microsurgical anastomosis was then performed between the right and the left SEA artery. The lateral deep epigastric vein (DIEV) was left intact to drain the flap. Perfusion of the flap was confirmed clinically by laser Doppler and by flowmetry. Results One flap failure was observed in this study that occurred on postoperative day (POD) 5 as a consequence of venous occlusion due to hematoma. There was a significant initial drop in arterial flow across the anastomosis in comparison to preanastomotic flow measurements (p < 0.05); however, this was normalized by the seventh POD (p > 0.05). Flow measurements in the vein significantly increased after the arterial anastomosis was completed and the seventh POD (p < 0.05). Laser Doppler assessment demonstrated adequate tissue perfusion of the skin island flap. Conclusion This modified VRAM flap is a viable procedure to simulate a free flap transfer and assess the arterial anastomosis alone, while maintaining the flap's innate venous drainage. This method can allow the investigation of new arterial anastomosis techniques and devices.

scholarly journals Computed tomography angiographic study of internal mammary perforators and their use as recipient vessels for free tissue transfer in breast reconstruction

2017 ◽  
Vol 50 (01) ◽  
pp. 050-055
Author(s):  
Aditya V. Kanoi ◽  
Karnav B. Panchal ◽  
Saugata Sen ◽  
Gautam Biswas
Keyword(s):  
Computed Tomography ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Tissue Transfer ◽  
Free Flap Transfer ◽  
Internal Mammary ◽  
Multiple Variables ◽  
The Right ◽  
Artery Perforator

ABSTRACT Context: The internal mammary artery perforator vessels (IMPV) as a recipient in free flap breast reconstruction offer advantages over the more commonly used thoracodorsal vessels and the internal mammary vessels (IMV). Aims: This study was designed to assess the anatomical consistency of the IMPV and the suitability of these vessels for use as recipients in free flap breast reconstruction. Patients and Methods: Data from ten randomly selected female patients who did not have any chest wall or breast pathology but had undergone a computed tomography angiography (CTA) for unrelated diagnostic reasons from April 2013 to October 2013 were analysed. Retrospective data of seven patients who had undergone mastectomy for breast cancer and had been primarily reconstructed with a deep inferior epigastric artery perforator free flap transfer using the IMPV as recipient vessels were studied. Results: The CTA findings showed that the internal mammary perforator was consistently present in all cases bilaterally. In all cases, the dominant perforator arose from the upper four intercostal spaces (ICS) with the majority (55%) arising from the 2nd ICS. The mean distance of the perforators from the sternal border at the level of pectoralis muscle surface on the right side was 1.86 cm (range: 0.9–2.5 cm) with a mode value of 1.9 cm. On the left side, a mean of 1.77 cm (range: 1.5–2.1 cm) and a mode value of 1.7 cm were observed. Mean perforator artery diameters on the right and left sides were 2.2 mm and 2.4 mm, respectively. Conclusions: Though the internal mammary perforators are anatomically consistent, their use as recipients in free tissue transfer for breast reconstruction eventually rests on multiple variables.

Miniature Implantable Laser Doppler Probe Monitoring of Free Tissue Transfer

1988 ◽  
Vol 20 (5) ◽  
pp. 434-442 ◽  
Author(s):  
Barry Fernando ◽  
V Leroy Young ◽  
Samuel E. Logan
Keyword(s):  
Free Tissue Transfer ◽  
Laser Doppler ◽  
Doppler Probe ◽  
Tissue Transfer

Rectus abdominis free tissue transfer in lower extremity reconstruction: Long term follow up in 58 cases

Injury ◽  
2019 ◽  
Vol 50 ◽  
pp. S25-S28 ◽  
Author(s):  
Ramzi C. Moucharafieh ◽  
Alexandre H. Nehme ◽  
Mohammad I. Badra ◽  
Mohammad Jawad H. Rahal
Keyword(s):  
Lower Extremity ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Tissue Transfer ◽  
Long Term Follow Up ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

scholarly journals Pulmonary Atelectasis After Reconstruction With a Rectus Abdominis Free Tissue Transfer

2002 ◽  
Vol 128 (3) ◽  
pp. 249 ◽  
Author(s):  
Mark K. Wax ◽  
Eben L. Rosenthal ◽  
Rodd Takaguchi ◽  
James I. Cohen ◽  
Peter E. Andersen ◽  
...  
Keyword(s):  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Pulmonary Atelectasis ◽  
Tissue Transfer

scholarly journals Microvascular free tissue transfer of the rectus abdominis muscle in dogs

2002 ◽  
Vol 31 (1) ◽  
pp. 32-43 ◽  
Author(s):  
Earl F. Calfee ◽  
Otto I. Lanz ◽  
Daniel A. Degner ◽  
Steven L. Peterson ◽  
Robert B. Duncan ◽  
...  
Keyword(s):  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
Tissue Transfer

scholarly journals Meta-analysis of arterial anastomosis techniques in head and neck free tissue transfer

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249418
Author(s):  
Yu-Jing Wang ◽  
Xiu-Ling Wang ◽  
Shan Jin ◽  
Ran Zhang ◽  
Yu-Qin Gao
Keyword(s):  
Head And Neck ◽  
Arterial Thrombosis ◽  
Meta Analysis ◽  
Free Tissue Transfer ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Tissue Transfer ◽  
Vascular Compromise ◽  
Arterial Anastomosis ◽  
Anastomotic Devices

The present meta-analysis aimed to investigate the differences in the incidence of thrombosis and vascular compromise in arterial anastomosis between microvascular anastomotic devices and hand-sewn techniques during free tissue transfer in the head and neck. We searched for articles in PubMed/Medline, CNKI, WANFANG DATA, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science, from January 1, 1962 till April 1, 2020 that reported data of microvascular anastomosis during free tissue transfer in the head and neck. The incidence of arterial thrombosis or vascular compromise, or both was the primary outcome. The secondary outcome was anastomotic time. We also assessed the sensitivity and the risk of bias. This meta-analysis included 583 arterial anastomoses from six studies. The group using microvascular anastomotic devices tended to have an increased incidence of arterial thrombosis and vascular compromise (risk ratio (RR), 3.42; P = 0.38; 95% confidence interval (CI), 0.91–12.77). The hand-sewn technique took significantly longer to perform the anastomosis compared with that of the microvascular anastomotic devices (weighted mean difference, 15.26 min; P<0.01; 95% CI, 14.65–15.87). Microvascular anastomotic devices might increase the risk of arterial thrombosis and vascular compromise compared with the hand-sewn technique; however, further randomized controlled trials are needed to provide a more accurate estimate. The application of microvascular anastomotic devices will help to reduce anastomotic surgery time and achieve acceptable vessel opening, benefiting from the developments of arterial couplers and microsurgical techniques.

scholarly journals Use of the Retrograde Recipient Vein for Additional Outflow in Free Tissue Transfer

2020 ◽  
Vol 05 (01) ◽  
pp. e1-e6
Author(s):  
Tetsuji Uemura ◽  
Mamoru Kikuchi ◽  
Hidetaka Watanabe ◽  
Tetsu Yanai
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Blood Perfusion ◽  
Free Flaps ◽  
Successful Outcome ◽  
Venous Anastomosis ◽  
Venous Flow ◽  
Flap Transfer ◽  
Tissue Transfer ◽  
Free Flap Transfer

Abstract Background The selection of appropriate recipient vessels is essential to the successful outcome of free flap transfer. To improve blood perfusion after reconstruction and reduce the risk of postoperative obstruction of flap vessels, multiple vessels should be chosen as candidate recipients. Methods For certainty of venous drainage, we have been performing venous anastomosis to the distal end of the recipient vein to utilize the reverse venous flow. Results A total of 48 cases of reconstruction of the head and neck or breast region with free flaps using retrograde venous anastomosis were performed. The method possibly improves flap circulation and the success rate of the free tissue transfer and reduces the need to extend surgery to search for multiple recipient veins. Conclusion We emphasized that retrograde limb of vein is useful as a second and/or rescued recipient in free tissue transfer. Retrograde venous anastomosis is a fine and reasonable option when appropriate recipient vessels cannot be found near the defect in the head and neck such as frozen neck or breast region.

scholarly journals Rectus Abdominis Free-Tissue Transfer in Lower Extremity Reconstruction: Review of 40 Cases

2007 ◽  
Vol 23 (2) ◽  
pp. 120-120
Author(s):  
Ramzi Musharrafieh ◽  
George Macari ◽  
Shadi Hayek ◽  
Bassem Elhassan ◽  
Bishara Atiyeh
Keyword(s):  
Lower Extremity ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Tissue Transfer ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

scholarly journals Salvage of a TRAM breast reconstruction flap using the retrograde internal mammary artery system

2014 ◽  
Vol 47 (03) ◽  
pp. 447-449
Author(s):  
Sameena Hassan ◽  
Tuabin Rasheed ◽  
Anna Raurell
Keyword(s):  
Breast Reconstruction ◽  
Vessel Wall ◽  
Internal Mammary Artery ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Arterial System ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Tissue Transfer ◽  
Internal Mammary ◽  
Over Time

ABSTRACT Background: Free tissue transfer provides an optimal means for breast reconstruction in creating an aesthetically natural appearance that is durable over time. The choice of donor vessels vary from surgeon to surgeon, but the internal mammary axis is one of the most popular choices together with the thoracodorsal vessels. Aims and Results: We present the case of a salvaged free transverse rectus abdominis myocutaneous breast reconstruction in which end-to-end antegrade anastomosis to the internal mammary artery (IMA) was not possible due to frail vessel walls, but retrograde anastomosis to the IMA and antegrade anastomosis of internal mammary vessel resulted in a perfused and viable flap. Conclusion: We suggest the use of the retrograde internal mammary arterial system for microsurgical anastomosis when the anterograde flow is not adequate, the vessel wall is friable, and when other more common options are not available.

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