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 Mechanical Anastomotic Coupling Device versus Hand-sewn Venous Anastomosis in Head and Neck Reconstruction—An Analysis of 1694 Venous Anastomoses

2021 ◽  
Vol 54 (02) ◽  
pp. 118-123
Author(s):  
Rajan Arora ◽  
Kripa Shanker Mishra ◽  
Hemant T. Bhoye ◽  
Ajay Kumar Dewan ◽  
Ravi K. Singh ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Head And Neck ◽  
Free Tissue Transfer ◽  
Effective Alternative ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Neck Reconstruction ◽  
Coupling Device ◽  
Tissue Transfer ◽  
Flap Loss

Abstract Background There is a steep learning curve to attain a consistently good result in microvascular surgery. The venous anastomosis is a critical step in free-tissue transfer. The margin of error is less and the outcome depends on the surgeon’s skill and technique. Mechanical anastomotic coupling device (MACD) has been proven to be an effective alternative to hand-sewn (HS) technique for venous anastomosis, as it requires lesser skill. However, its feasibility of application in emerging economy countries is yet to be established. Material and Method We retrospectively analyzed the data of patients who underwent free-tissue transfer for head and neck reconstruction between July 2015 and October 2020. Based on the technique used for the venous anastomosis, the patients were divided into an HS technique and MACD group. Patient characteristics and outcomes were measured. Result A total of 1694 venous anastomoses were performed during the study period. There were 966 patients in the HS technique group and 719 in the MACD group. There was no statistically significant difference between the two groups in terms of age, sex, prior radiotherapy, prior surgery, and comorbidities. Venous thrombosis was noted in 62 (6.4%) patients in the HS technique group and 7 (0.97%) in the MACD group (p = 0.000). The mean time taken for venous anastomosis in the HS group was 17 ± 4 minutes, and in the MACD group, it was 5 ± 2 minutes (p = 0.0001). Twenty-five (2.56%) patients in the HS group and 4 (0.55%) patients in MACD group had flap loss (p = 0.001). Conclusion MACD is an effective alternative for HS technique for venous anastomosis. There is a significant reduction in anastomosis time, flap loss, and return to operation theater due to venous thrombosis. MACD reduces the surgeon’s strain, especially in a high-volume center. Prospective randomized studies including economic analysis are required to prove the cost-effectiveness of coupler devices.

End-to-Side Venous Anastomosis to a Ligated Vein Stump for Free Flap Transfer in Head and Neck Reconstruction

2019 ◽  
Vol 83 (2) ◽  
pp. 180-182
Author(s):  
Toshifumi Akazawa ◽  
Mitsuru Sekido ◽  
Koji Adachi ◽  
Kaoru Sasaki ◽  
Yukiko Aihara ◽  
...  
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Flap Transfer ◽  
Neck Reconstruction ◽  
Free Flap Transfer

Microvascular Flaps in Nasal Reconstruction

2017 ◽  
Vol 33 (01) ◽  
pp. 074-081 ◽  
Author(s):  
Kofi Boahene ◽  
Patrick Byrne ◽  
Shaun Desai ◽  
Irene Kim
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Nasal Reconstruction ◽  
Flap Transfer ◽  
Structural Support ◽  
Tissue Transfer ◽  
Free Flap Transfer ◽  
Long Term Changes ◽  
Optimal Reconstruction

AbstractNasal reconstruction for subtotal and total rhinectomy defects is a challenging endeavor, which requires technical finesse, a keen artistic eye, and the ability to anticipate long-term changes that accompany postoperative healing. While local and regional flaps have traditionally been utilized to reconstitute missing nasal elements, certain situations may not provide sufficient or acceptable tissue for optimal reconstruction. In these situations, the three major components of the nose—lining, structural support, and external skin—may require reconstruction with tissues harvested from distant sites through microvascular free tissue transfer. Our objective in this article is to discuss the general approach to nasal reconstruction and present the considerations for free tissue transfer with regard to each nasal component. The virtues of free flap transfer as well as its shortcomings and potential complications are discussed.

The use of free tissue transfer in reconstruction following head and neck tumour resection

1986 ◽  
Vol 100 (1) ◽  
pp. 97-104 ◽  
Author(s):  
M. C. Framption ◽  
N. M. Breach ◽  
D. J. Archer ◽  
H. J. Shaw
Keyword(s):  
Head And Neck ◽  
Malignant Disease ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tumour Resection ◽  
Advantages And Disadvantages ◽  
Neck Tumour ◽  
Tissue Transfer ◽  
Tissue Flaps ◽  
Methods Of Reconstruction

AbstractForty four free vascularised tissue flaps have been used in the reconstruction of defects arising following the treatment of malignant disease of the head and neck in 42 patients over the period January 1983 to September 1984. The uses of free flaps and their advantages and disadvantages when compared with other methods of reconstruction are described.

End-to-Side Venous Anastomosis With an Anastomotic Coupling Device for Microvascular Free-Tissue Transfer in Head and Neck Reconstruction

2008 ◽  
Vol 118 (12) ◽  
pp. 2146-2150 ◽  
Author(s):  
Natalya Chernichenko ◽  
Douglas A. Ross ◽  
Joseph Shin ◽  
Clarence T. Sasaki ◽  
Stephen Ariyan
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Head And Neck Reconstruction ◽  
Venous Anastomosis ◽  
Neck Reconstruction ◽  
Coupling Device ◽  
Tissue Transfer

scholarly journals Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

2021 ◽  
Vol 06 (01) ◽  
pp. e35-e39
Author(s):  
Chelsi Robertson ◽  
Charles Patterson ◽  
Hugo St. Hilaire ◽  
Frank H. Lau
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Final Analysis ◽  
The United States ◽  
Local Flap ◽  
Recurrence Rates ◽  
Tissue Transfer ◽  
Cochrane Database

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

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