scholarly journals Recurrent Venous Thrombosis following Free Flap Surgery: The Role of Heparin-Induced Thrombocytopenia

2003 ◽  
Vol 11 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Andreas Nikolis ◽  
Apostolos Christopoulos ◽  
Michel Saint-Cyr ◽  
Carlos Cordoba ◽  
Louis Guertin ◽  
...  
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Tobacco Consumption ◽  
Heparin Induced Thrombocytopenia ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
History Of ◽  
Recurrent Venous Thrombosis ◽  
High Index Of Suspicion

Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, ‘rare’ causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption.

Free Flap Head and Neck Reconstruction with an Emphasis on Postoperative Care

2018 ◽  
Vol 34 (06) ◽  
pp. 597-604 ◽  
Author(s):  
Jacob D'Souza ◽  
Wendy King ◽  
Michael Bater ◽  
Daniel van Gijn
Keyword(s):  
Free Flap ◽  
Microvascular Complications ◽  
Free Tissue Transfer ◽  
Congenital Defects ◽  
Head And Neck Reconstruction ◽  
Functional Rehabilitation ◽  
Immediate Reconstruction ◽  
Flap Failure ◽  
Tissue Transfer ◽  
Free Flap Monitoring

AbstractMicrosurgical free tissue transfer represents the mainstay of care in both ablative locoregional management and the simultaneous reconstruction of a defect. Advances in microsurgical techniques have helped balance the restoration of both form and function—decreasing the significant morbidity once associated with large ablative, traumatic, or congenital defects—while providing immediate reconstruction enabling early aesthetic and functional rehabilitation. There are a multitude of perioperative measures and considerations that aim to maximize the success of free tissue transfer. These include nutritional support, tight glycemic control, acknowledgment of psychological and psychiatric factors, intraoperative surgical technique, and close postoperative monitoring of the patients' hemodynamic physiology. While the success rates of free tissue transfer in experienced hands are comparable to alternative options, the consequences of flap failure are catastrophic—with the potential for significant patient morbidity, prolonged hospital stay (and associated increased financial implications), and increasingly limited options for further reconstruction. Success is entirely dependent on a continuous arterial inflow and venous outflow until neovascularization occurs. Flap failure is multifactorial and represents a dynamic process from the potentially reversible failing flap to the necrotic irreversibly failed flap—necessitating debridement, prolonged wound care, and ultimately decisions concerned with future reconstruction. The overriding goal of free flap monitoring is therefore the detection of microvascular complications prior to permanent injury occurring—identifying and intervening within that critical period between the failing flap and the failed flap—maximizing the potential for salvage. With continued technique refinement, microvascular free flap reconstruction offers patients the chance for both reliable functional and aesthetic restoration in the face of significant ablative defects. The caveat to this optimism is the requirement for considered perioperative care and the optimization of those factors that may offer the difference between success and failure.

scholarly journals Taking Free Flap Surgery Abroad: A Collaborative Approach to a Complex Surgical Problem

2018 ◽  
Vol 160 (3) ◽  
pp. 426-428 ◽  
Author(s):  
Brian Swendseid ◽  
Patrick Tassone ◽  
Patrick Jean Gilles ◽  
Magda Pavrette ◽  
Matthew Stewart ◽  
...  
Keyword(s):  
Health Care ◽  
Free Flap ◽  
Health Care Disparities ◽  
Ethical Dilemmas ◽  
Surgical Care ◽  
Free Tissue Transfer ◽  
Outreach Program ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Surgical Teams

Accessibility to health care, especially complex surgical care, represents one of the major health care disparities in developing countries. While surgical teams may be willing to travel to these areas to help address these needs, there are many logistical and ethical dilemmas inherent in this pursuit. We reviewed our approach to the establishment of the team-based surgical outreach program, wherein we perform head and neck free tissue transfer surgery in Haiti. We describe the challenges encountered in the delivery of surgical care as well as ethical dilemmas relevant to surgical outreach trips, highlighting an approach reliant on strong local cooperation. Despite the obstacles in place, our experience shows that free flap surgery can be successfully and ethically performed in these areas of great need.

O129 An outcome audit of the role of the intensive care unit in free flap surgery and a national survey of UK experience

2007 ◽  
Vol 2 (1) ◽  
pp. 102
Author(s):  
R. Anand ◽  
S. Sharma ◽  
G. Murdoch ◽  
E.O. Sullivan ◽  
T. Mellor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
National Survey ◽  
Free Flap ◽  
Flap Surgery ◽  
Free Flap Surgery

scholarly journals Cross-Leg as Salvage Procedure after Free Flaps Transfer Failure: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
F. Contedini ◽  
L. Negosanti ◽  
E. Fabbri ◽  
V. Pinto ◽  
B. Tavaniello ◽  
...  
Keyword(s):  
Free Flap ◽  
Latissimus Dorsi ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Lower Leg ◽  
Salvage Procedure ◽  
Soft Tissue Defects ◽  
Vascular Thrombosis ◽  
Flap Failure ◽  
Tissue Defects

Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. Even when a free tissue transfer can be performed the risk of failure remains considerable. When a free flap is contraindicated or after a free flap failure, the cross-leg flap is still nowadays a possible option. We report a case of a male with a severe posttraumatic wound of the lower leg with exposed tibia fracture firstly treated with two consecutive latissimus dorsi muscular free flaps, failed for vascular thrombosis; the coverage was then achieved with a cross-leg flap with acceptable results.

scholarly journals The “Fountain of Death”: A Case Series on Tracheo-innominate Artery Fistula

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
Jason Lo ◽  
Marina Mat Baki ◽  
Yeoh Xing Yi ◽  
Nik Hisyam Amirul ◽  
Zahirrudin Zakaria
Keyword(s):  
Potential Role ◽  
Rare Complication ◽  
Case Series ◽  
Innominate Artery ◽  
Survival Outcomes ◽  
Permissive Hypotension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion

Tracheo-innominate artery fistula (TIF) is a very rare complication related to tracheostomy and has been reported in 0.7% of patients, but certainly is one of the most life-threatening conditions. It is of paramount importance to maintain a high index of suspicion in evaluating patients with TIF and to anticipate occurrence of massive haemorrhage even during simple procedures related to tracheostomy such as tube change. We report 3 cases of TIF, each with a unique and unsuspecting history of the condition and review the emergency protocol in arresting the bleeding. We’ve also highlighted the potential role of permissive hypotension with sedation in improving survival outcomes of patients with TIF.

scholarly journals The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction

2009 ◽  
Vol 42 (01) ◽  
pp. 094-099 ◽  
Author(s):  
A. Z. Mat Saad ◽  
T. L. Khoo ◽  
A. A. Dorai ◽  
A. S. Halim
Keyword(s):  
Free Flap ◽  
Antimicrobial Properties ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Adjunctive Treatment ◽  
Flap Surgery ◽  
Skin Allograft ◽  
Skin Allografts ◽  
Free Flap Surgery ◽  
Unique Composition

ABSTRACTSkin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.

Prevention of Oral Candidiasis After Free Flap Surgery: Role of 3% Sodium Bicarbonate Saline in Oral Care

2017 ◽  
Vol 75 (3) ◽  
pp. 641-647
Author(s):  
Yue Yang ◽  
Fang Zhang ◽  
Xin Lyu ◽  
Zhimin Yan ◽  
Hong Hua ◽  
...  
Keyword(s):  
Sodium Bicarbonate ◽  
Free Flap ◽  
Oral Candidiasis ◽  
Oral Care ◽  
Flap Surgery ◽  
Free Flap Surgery

scholarly journals One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 91-98
Author(s):  
Jennifer L. K. Matthews ◽  
Noor Alolabi ◽  
Forough Farrokhyar ◽  
Sophocles H. Voineskos
Keyword(s):  
Systematic Review ◽  
Free Flap ◽  
Meta Analysis ◽  
Venous Congestion ◽  
Flap Surgery ◽  
Flap Failure ◽  
Free Flap Surgery ◽  
Significant Difference ◽  
Reoperation Rates ◽  
Venous Flap

Background: The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems. Methods: A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs). Results: Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27). Conclusions: There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.

Sign in / Sign up

Export Citation Format

Share Document