Radial Artery Fascial Flow-Through Free Flap for Combined Revascularization in Moyamoya Disease

2017 ◽  
Vol 14 (2) ◽  
pp. 139-144 ◽  
Author(s):  
Jonathan Russin ◽  
Joseph Carey
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Free Flap ◽  
Anterior Cerebral Artery ◽  
Single Case ◽  
Free Flaps ◽  
Soft Tissue Reconstruction ◽  
Single Case Report ◽  
Proximal Anterior Cerebral Artery ◽  
Flow Through

Abstract BACKGROUND Free flaps are commonly used by other surgical subspecialties for soft tissue reconstruction and revascularization. Cranial applications of these flaps have been limited to only a single case report. OBJECTIVE To present a new technique for combined revascularization in moyamoya disease using a flow-through free flap. METHODS Data were obtained from an Institutional Review Board-approved, prospectively maintained database with informed consent from the patient. RESULTS A 28-yr-old patient presented with progressive stenosis of the proximal anterior cerebral artery resulting in ischemic infarcts. Direct revascularization of the anterior cerebral artery territory and indirect revascularization of the middle cerebral artery with a large vascularized fascial pedicle was performed. CONCLUSION Flow-through free flaps offer a unique combination of revascularization and a large vascularized pedicle. This technique highlights the application of these flaps for revascularization in moyamoya disease and the value of multidisciplinary collaboration. Revascularization will likely play an increasing role in the open surgical treatment of cerebrovascular disease. We believe that flow-through free flaps will be a contribution to the future of revascularization in neurosurgery.

Radial Artery Fascial Flow-Through Free Flap for Complex Cerebral Revascularization: Technical Notes and Long-Term Neurologic and Radiographic Outcomes

2018 ◽  
Vol 16 (4) ◽  
pp. 424-434 ◽  
Author(s):  
Robert C Rennert ◽  
Kristine Ravina ◽  
Ben A Strickland ◽  
Joshua Bakhsheshian ◽  
Joseph Carey ◽  
...  
Keyword(s):  
Radial Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Free Flap ◽  
Free Flaps ◽  
Graft Patency ◽  
Wound Complications ◽  
Bifurcation Aneurysm ◽  
Flow Through

AbstractBACKGROUNDSurgical innovation is critical for the management of challenging cerebrovascular pathology. Flow-through free flaps are versatile composite grafts that combine viable tissue with a revascularization source. Neurosurgical experience with these flaps is limited.OBJECTIVETo provide an in-depth technical description of the radial artery fascial (and fasciocutaneous) flow-through free flap (RAFF and RAFCF, respectively) for complex cerebral revascularizations.METHODSAn Institutional Review Board-approved, prospective database was retrospectively reviewed to identify patients that underwent extracranial-to-intracranial cerebral bypass with a RAFF or RAFCF. Patient demographics, underlying pathology, surgical treatment, complications, and outcomes were recorded.RESULTSA total of 4 patients were treated with RAFFs or RAFCFs (average age 40 ± 8.8 yr). Two patients with progressive moyamoya disease involving multiple vascular territories with predominantly anterior cerebral artery (ACA) symptoms and flow alterations underwent combined direct ACA and indirect middle cerebral artery (MCA) bypass with a RAFF. The third patient with moyamoya disease and concomitant proximal fusiform aneurysms requiring internal carotid artery sacrifice underwent dual direct ACA and MCA bypass and indirect MCA revascularization with posterior tibial artery and RAFF grafts. The fourth patient with a large MCA bifurcation aneurysm and recurrent wound complications underwent a direct MCA bypass and complex wound reconstruction using a RAFCF. Good neurologic outcomes (Glasgow Outcomes Scale score ≥4 at discharge) were achieved in all patients. There were no perioperative surgical complications, and graft patency was confirmed on long-term follow-up.CONCLUSIONThe RAFF and RAFCF are versatile grafts for complex cerebral revascularizations.

Achilles Region Soft-Tissue Defects: A Reconstructive Algorithm Based on a Series of 46 Cases

2017 ◽  
Vol 33 (S 01) ◽  
pp. S40-S47 ◽  
Author(s):  
Marco Innocenti ◽  
Serena Ghezzi ◽  
Luca Delcroix ◽  
Alessandro Innocenti
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Single Case ◽  
Weight Bearing ◽  
Free Flaps ◽  
Full Weight Bearing ◽  
Medium Size ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction ◽  
Reconstructive Algorithm

Background Several options have been described for soft-tissue reconstruction in Achilles tendon region (ATR). The best procedure should be customized according to any single case taking into account the number of structures involved, the quality of the neighboring skin, and patient's general condition. The aim of this article is to describe a simplified reconstructive algorithm based on personal experience and reviewing literature. Methods Forty-four patients, who underwent ATR soft-tissue reconstruction between 1998 and 2016, have been retrospectively reviewed. Etiologies of the defect include the following: 18 posttraumatic, 10 postoncologic, 14 dehiscence/infection, and 2 chronic ulcers. Follow-up ranges between 12 and 96 months. Free flaps have been used in 30 cases (including two secondary surgeries due to propeller flap failure) and propeller flaps have been used in 16 cases. Results Thirty-six flaps survived uneventfully (78.3%). Total flap necrosis occurred in three cases (6.5%), namely, two propeller flaps and one free flap. Partial necrosis of the flap was observed in seven cases (15, 2%): three in the free flap group and four in the propeller group. The functional recovery was very good in all the patients without involvement of the tendon and also all the patients who underwent a simultaneous reconstruction of the tendon with different techniques recovered a full weight bearing and a satisfactory range of motion. Conclusion Propeller flaps are a valuable option for skin reconstruction in case of defects of small and medium size not involving the tendon. In case of larger defects and when a simultaneous ATR reconstruction is required, a free flap seems to be a better option.

Clinical Features of Proximal Anterior Cerebral Artery Aneurysms

2011 ◽  
Vol 39 (5) ◽  
pp. 353-358
Author(s):  
Masayuki KANAMORI ◽  
Hiroki TAKAZAWA ◽  
Shingo YONEZAWA ◽  
Shunsuke OMODAKA ◽  
Tomohiro KAWAGUCHI ◽  
...  
Keyword(s):  
Clinical Features ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Proximal Anterior Cerebral Artery

An Analysis of Proximal Anterior Cerebral Artery Aneurysms

1998 ◽  
Vol 26 (3) ◽  
pp. 164-170
Author(s):  
Masahiko WANIBUCHI ◽  
Masahito FUJISHIGE ◽  
Michio INOUE ◽  
Katsuyuki NUNOMURA ◽  
Kenichi INABA
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Proximal Anterior Cerebral Artery

Reconstruction of Large Palmar Defects of the Hand Using Free Flaps

1997 ◽  
Vol 22 (5) ◽  
pp. 623-630 ◽  
Author(s):  
M. M. NINKOVÍC ◽  
A. H. SCHWABEGGER ◽  
G. WECHSELBERGER ◽  
H. ANDERL
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Subcutaneous Tissue ◽  
Free Flaps ◽  
Difficult Problem ◽  
Glabrous Skin ◽  
Soft Tissue Reconstruction ◽  
Anatomical Structures ◽  
Tissue Reconstruction ◽  
Restoration Of Sensibility

The reconstruction of large palmar defects of the hand remains a difficult problem due to the specific anatomical structures and highly sophisticated function of the palm. The glabrous skin and subcutaneous tissue in the palm are perfectly adapted to serve the prehensile function. The particular aim must be that repairs to this functional structure are similar in texture and colour and are aesthetically acceptable. Restoration of sensibility is desirable. For smaller defects a great variety of local pedicled or island flaps can be applied. However, for larger defects with exposed tendons, nerves or other essential structures, free flaps remain as a reliable alternative. This paper reviews our approach of soft tissue reconstruction in 16 patients with large palmar defects using various kinds of free flaps. The advantages, disadvantages and current indications for free flap resurfacing of the palm are discussed.

Aneurysmal subarachnoid hemorrhage in a patient with bilateral A1 fenestrations associated with an azygos anterior cerebral artery

1996 ◽  
Vol 84 (4) ◽  
pp. 681-684 ◽  
Author(s):  
Robert M. Friedlander ◽  
Christopher S. Ogilvy
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Vascular Anatomy ◽  
Vascular Anomaly ◽  
Rare Occurrence ◽  
Content Type ◽  
Proximal Anterior Cerebral Artery ◽  
Current Article

✓ Fenestration of the proximal anterior cerebral artery (A1 segment) is a rare occurrence. This vascular anomaly is often associated with aneurysms and other abnormalities. The current article describes the case of a 33-year-old man who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm originating from the proximal end of an A1 fenestration. This patient also had a contralateral A1 fenestration as well as an azygos anterior cerebral artery. This is the first report of such an unusual vascular anatomy. The literature is reviewed and possible embryological mechanisms are discussed.

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