LATERAL ARM FREE FLAPS IN THE DEFECTS OF THE UPPER EXTREMITY — A REVIEW OF 72 CASES

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 177-185 ◽  
Author(s):  
M. Akinci ◽  
Ş Ay ◽  
S. Kamiloglu ◽  
Ö. Erçetin
Keyword(s):  
Venous Thrombosis ◽  
Upper Extremity ◽  
Failure Rate ◽  
High Voltage ◽  
Free Flaps ◽  
Perforator Flaps ◽  
Operative Duration ◽  
Anastomosis Site ◽  
Extended Approach ◽  
Forearm Skin

Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. Five patients were operated on as emergencies, 12 were operated within the first 72 hours of injury and 57 patients were treated electively. Skin defects were between 6 × 4 cm and 20 × 9 cm . Five (7%) flaps were lost due to venous thrombosis, three that sustained a high-voltage electric burn. Two other patients that were treated for a high-voltage electric burn had a successful revision of the anastomosis site in the early post-operative duration. One flap was abandoned due to very thin pedicle and obesity of the patient. A higher failure rate is encountered most frequently with the cases of high-voltage electric burn. To deal with this problem, a modified approach such as an extended approach and/or including the forearm skin to the flap is recommended during the flap harvest. For a longer pedicle to be anatomized more proximally, perforator flaps with longer pedicles may be used as an alternative.

scholarly journals Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

2021 ◽  
pp. 229255032110247
Author(s):  
Minh N. Q. Huynh ◽  
Vinai Bhagirath ◽  
Michael Gupta ◽  
Ronen Avram ◽  
Kevin Cheung
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Perceived Risk ◽  
Management Strategies ◽  
Free Flaps ◽  
Low Molecular Weight ◽  
National Surveys ◽  
Flap Failure ◽  
Multidisciplinary Practice ◽  
Practice Variations

Background: Venous thrombosis, the leading cause of free flap failure, may have devastating consequences. Many anti-thrombotic agents and protocols have been described for prophylaxis and treatment of venous thrombosis in free flaps. Methods: National surveys were distributed to microsurgeons (of both Plastics and ENT training) and hematology and thrombosis specialists. Data were collected on routine screening practices, perceived risk factors for flap failure, and pre-, intra-, and post-operative anti-thrombotic strategies. Results: There were 722 surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 hematologists. Sixty-five surgeons and 9 hematologists routinely performed or managed patients with free flaps. The top 3 perceived risk factors for flap failure according to surgeons were medical co-morbidities, past arterial thrombosis, and thrombophilia. Hematologists, however, reported diabetes, smoking, and medical co-morbidities as the most important risk factors. Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) intra-operatively. Surgeons used a range of post-operative agents such as UFH, LMWH, aspirin, and dextran while hematologists preferred LMWH. There was variation of management strategies if flap thrombosis occurred. Different strategies consisted of changing recipient vessels, UFH IV, flushing the flap, adding post-operative agents, or a combination of strategies. Conclusions: There are diverse practice variations in anti-thrombotic strategies for free tissue transfers and a difference in perceived risk factors for flap failure that may affect patient management.

scholarly journals Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based population

1997 ◽  
Vol 26 (5) ◽  
pp. 853-860 ◽  
Author(s):  
Anil Hingorani ◽  
Enrico Ascher ◽  
Elke Lorenson ◽  
Patrick DePippo ◽  
Sergio Salles-Cunha ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Mortality Rates ◽  
Morbidity And Mortality

scholarly journals Can air plethysmography accurately identify upper extremity deep venous thrombosis?

1993 ◽  
Vol 18 (5) ◽  
pp. 808-813 ◽  
Author(s):  
Glenn P. Gardner ◽  
Paul R. Cordts ◽  
David L. Gillespie ◽  
Wayne LaMorte ◽  
Jonathan Woodson ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Air Plethysmography

Designing Lateral Thoracic Wall Perforator Flaps for Breast Reconstruction Using the Ultrasound

2021 ◽  
Author(s):  
Marzia Salgarello ◽  
Giuseppe Visconti
Keyword(s):  
Breast Reconstruction ◽  
Duplex Ultrasound ◽  
Free Flaps ◽  
Thoracic Wall ◽  
Perforator Flaps ◽  
Thoracodorsal Artery ◽  
The Us ◽  
Latissimus Dorsi Myocutaneous Flap ◽  
Artery Perforator ◽  
Color Duplex Ultrasound

Abstract Background Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps. Patients and Methods From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap. Results Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed. Conclusion Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.

Risk and prognosis of cancer after upper-extremity deep venous thrombosis: A population-based cohort study

2018 ◽  
Vol 161 ◽  
pp. 106-110 ◽  
Author(s):  
Kasper Adelborg ◽  
Erzsébet Horváth-Puhó ◽  
Jens Sundbøll ◽  
Paolo Prandoni ◽  
Anne Ording ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Upper Extremity ◽  
Population Based

scholarly journals Comparison of Fasciocutaneous and Muscle-based Free Flaps for Soft Tissue Reconstruction of the Upper Extremity

2019 ◽  
Vol 7 (12) ◽  
pp. e2543
Author(s):  
Christoph Koepple ◽  
Ann-Katrin Kallenberger ◽  
Lukas Pollmann ◽  
Gabriel Hundeshagen ◽  
Volker J. Schmidt ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Free Flaps ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction
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