scholarly journals Hemodynamic Principles in Free Tissue Transfer: Vascular Changes at the Anastomosis Site

2021 ◽  
Author(s):  
GyeongHyeon Doh ◽  
BumSik Kim ◽  
DongYun Lee ◽  
JungSoo Yoon ◽  
SooA Lim ◽  
...  
Keyword(s):  
Blood Flow ◽  
Free Tissue Transfer ◽  
Middle Finger ◽  
Anastomotic Site ◽  
Digital Artery ◽  
Confined Spaces ◽  
Anastomosis Site ◽  
Flap Procedure ◽  
Intimal Injury ◽  
Static Flow

Purpose: Various factors such as blood velocity, turbulent flow,and intimal injury are the most basic elements in free tissue transfers. However, how blood flow is reestablished, maintained, and changed after vascular anastomosis has rarely been studied.Methods: A 54-year-old male sustained an unreplantable severe crushing injury to his right hand. The middle finger was transferred to the thumb as an ectopic replantation using an anastomosis between the radial and digital arteries. However, secondary reconstruction for the first web space defect was inevitable and an anteromedial thigh free flap procedure was performed 2 months later using the previously anastomosed vessels. During the procedures, we noted morphologic changes in the microvessels and tried to explain those phenomena by applying the principles of hemodynamics.Results: Due to the discrepancy in vascular size between the radial and digital arteries, the velocity of the blood flow in the post-anastomotic site, which was the digital artery, must have been increased by Poiseuille’s law. Supposing that the velocity through the post-anastomotic site of the digital artery was increased, the pressure exerted by that flow decreased, resulting in more shrinkage of the vessel lumen of the digital artery by Bernoulli’s principle. Pascal’s law could also be applied in confined spaces with a static flow; where there is a constant pressure, as the radius of the post-anastomotic digital artery diminishes, the tension within the digital artery’s wall also simultaneously decreases. By Laplace’s law, the post-anastomotic digital artery’s wall thickens as less tension is exerted on the wall.Conclusion: Understanding these simple flow mechanics will enable microsurgeons to better avoid the risk factors causing thrombosis, which is related to flap failure.

The Effect of Caffeine on Digital Haemodynamics

1994 ◽  
Vol 19 (3) ◽  
pp. 301-302 ◽  
Author(s):  
B. BARTON ◽  
J. M. KLEINERT
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Room Temperature ◽  
Systolic Pressure ◽  
Middle Finger ◽  
Distal Phalanx ◽  
Normal Volunteers ◽  
Pulse Volume ◽  
Digital Pressure ◽  
Digital Blood Flow

Caffeine has been shown to increase mean blood pressure, but studies documenting the effect of caffeine on digits are lacking. We evaluated the effect of caffeine on digital blood pressure and pulse volume in normal volunteers. In the first part of the study, 24 subjects were given water containing either 200 mg of caffeine or placebo. Bilateral brachial and middle finger digital pressures were measured at room temperature before ingestion and at 30 and 60 minutes after ingestion. In the second part of the study, pulse volume recordings (PVRs) were obtained in 24 subjects at the level of the distal phalanx of the middle finger of one hand immediately prior to beverage ingestion and at 10 minute intervals for 90 minutes. Differences in mean digital systolic pressure, digital/brachial index, or PVR amplitude between the control and caffeine groups were not statistically significant. The administration of caffeine was found not to alter the haemodynamics of digital blood flow or digital pressure in this population.

Postoperative Blood Flow Monitoring after Free-Tissue Transfer by Means of the Hydrogen Clearance Technique

1997 ◽  
Vol 99 (2) ◽  
pp. 493-505 ◽  
Author(s):  
Hans-Guenther Machens ◽  
Peter Mailaender ◽  
Ralf Reimer ◽  
Norbert Pallua ◽  
Yuan Lei ◽  
...  
Keyword(s):  
Blood Flow ◽  
Free Tissue Transfer ◽  
Flow Monitoring ◽  
Tissue Transfer ◽  
Hydrogen Clearance ◽  
Clearance Technique

scholarly journals Modified Recipient Blood Flow-Preserved Cross-Leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

2021 ◽  
Author(s):  
Hong-Xiang Zhou ◽  
Liang He ◽  
Dong Yin ◽  
Yang Niu ◽  
Zhe Jin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lower Limb ◽  
Posterior Tibial Artery ◽  
Anterolateral Thigh Flap ◽  
Posterior Tibial ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Flap Procedure ◽  
Tissue Defects

Abstract Background Complex lower limb reconstruction following severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy. Methods Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injuries underwent modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the contralateral posterior tibial artery in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the defects. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The vascular pedicle was divided 4 weeks after vascular anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the recipient posterior tibial artery during postoperative follow-up. Results All 22 flaps survived. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. Eighteen flaps were designed in a single fashion, and four flaps were bilobed. Twenty patients underwent fasciocutaneous flap transplantation, and two underwent musculocutaneous flap transplantation. Two cases developed local lysis of the flap, and the wound healed after further debridement. Direct suture of the donor-site incision was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients with severe tibia bone defects. Blood flow of recipient posterior tibial arteries was confirmed during follow-up. All flaps recovered sensation at the final follow-up. The postoperative follow-up ranged from 18 to 84 months, and no long-term complications were observed. Conclusions The modified recipient blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair large tissue defects without sacrificing the major artery of the uninjured lower limb.

scholarly journals Direction Change in Distal Bypass Graft due to Increased Collateral Perfusion after the Free Flap Transfer

2021 ◽  
Author(s):  
Dongkyung Seo ◽  
Yutaka Dannoura ◽  
Riku Ishii ◽  
Keisuke Tada ◽  
Katsumi Horiuchi
Keyword(s):  
Blood Flow ◽  
Free Flap ◽  
Popliteal Artery ◽  
Bypass Graft ◽  
Muscle Flap ◽  
Anastomotic Site ◽  
Dorsalis Pedis Artery ◽  
Dermatology Clinic ◽  
Thoracodorsal Artery ◽  
Free Flap Transfer

Distal bypass combined with a free flap is a frequent surgical option for ischemic ulcers of the lower extremities. Here, we describe a patient in whom there was a change in the direction of blood flow in a distal bypass graft. A 68-year-old male patient with an ischemic ulcer on his left heel was referred to our facility by a local dermatology clinic. Surgical revascularization was performed between the popliteal artery and the dorsalis pedis artery using an ipsilateral great saphenous vein as the graft vessel. The wound site did not heal postoperatively, so it was covered using a free latissimus dorsi muscle flap. At the same time, the thoracodorsal artery was anastomosed to the bypass graft in an end-to-side manner to serve as a nutrient vessel. Initially, blood flow into the thoracodorsal artery from the bypass graft was via the popliteal artery. However, after occlusion of the proximal anastomotic site of the bypass graft, blood flow into the thoracodorsal artery from the bypass graft was via the dorsalis pedis artery, which was the distal anastomotic site. The change in direction of blood flow might have been the result of an increase in blood flow in the collateral vessels in the ischemic lower leg, which eventually overwhelmed the blood flow in the bypass graft.

scholarly journals Long-Term Outcomes of Digital Nerve Repair Accompanied by Digital Artery Injury in Flexor Zone 2

2019 ◽  
Vol 06 (01) ◽  
pp. e7-e9
Author(s):  
Gokce Yildiran ◽  
Mustafa Sutcu ◽  
Osman Akdag ◽  
Zekeriya Tosun
Keyword(s):  
Blood Flow ◽  
Blood Supply ◽  
Nerve Repair ◽  
Arterial Injury ◽  
Digital Artery ◽  
Digital Nerve ◽  
Significant Difference ◽  
Sensory Recovery

Abstract Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the “unrepaired artery group” (UA) and 24 patients in the “intact artery group” (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

Techniques of postoperative blood flow monitoring after free tissue transfer: An overview

Microsurgery ◽  
1994 ◽  
Vol 15 (11) ◽  
pp. 778-786 ◽  
Author(s):  
Hans-Guenther Machens ◽  
Peter Mailaender ◽  
Bernd Rieck ◽  
Alfred Berger
Keyword(s):  
Blood Flow ◽  
Free Tissue Transfer ◽  
Flow Monitoring ◽  
Tissue Transfer

Vasopressor-Dependent Recipient Vessel Blood Flow in Head and Neck Free Tissue Transfer: A Report of Two Cases

2015 ◽  
Vol 31 (06) ◽  
pp. 477-480
Author(s):  
Edward Swanson ◽  
Srinivas Susarla ◽  
Georgia Yalanis ◽  
Hsu-Tang Cheng ◽  
Denver Lough ◽  
...  
Keyword(s):  
Blood Flow ◽  
Head And Neck ◽  
Free Tissue Transfer ◽  
Recipient Vessel ◽  
Tissue Transfer

scholarly journals Reproducibility of the cold-induced vasodilation response in the human finger

2005 ◽  
Vol 98 (4) ◽  
pp. 1334-1340 ◽  
Author(s):  
Catherine O'Brien
Keyword(s):  
Blood Flow ◽  
Time Course ◽  
Cold Water ◽  
Temperature Response ◽  
Onset Time ◽  
Middle Finger ◽  
Warm Water ◽  
Finger Temperature ◽  
Nail Bed ◽  
Human Finger

Cold-induced vasodilation (CIVD) is a cyclic oscillation in blood flow that occurs in the extremities on cold exposure and that is likely associated with reduced risk of cold injury (e.g., frostbite) as well as improved manual dexterity and less pain while working in the cold. The CIVD response varies between individuals, but the within-subject reproducibility has not been adequately described. The purpose of this study was to quantify the within-subject variability in the CIVD response under standardized conditions. Twenty-one volunteers resting in a controlled environment (27°C) immersed the middle finger in warm water (42°C) for 15 min to standardize initial finger temperature and then in cold water (4°C; CWI) for 30 min, on five separate occasions. Skin temperature (Tf) and blood flow (laser-Doppler; expressed as percent change from warm-water peak) responses that describe CIVD were identified, including initial nadir reached during CWI, onset time of CIVD, initial apex during CIVD, time of that apex, and overall mean during CWI. Within-subject coefficient of variation for Tfacross the five tests for the nail bed and pad, respectively, were as follows: nadir, 9 and 21%; onset, 18 and 19%; apex, 12 and 17%; apex time, 23 and 24%; mean 10 and 15%. For blood flow, these values were as follows: nadir 52 and 64%; onset, 6 and 5%; apex, 33 and 31%; apex time 9 and 8%; and mean 43 and 34%. Greater variability was found in the temperature response of the finger pad than the nail bed, but for blood flow the variability was similar between locations. Variability in onset and apex time between sites was similar for both temperature and blood flow responses. The reproducibility of the time course of CIVD suggests this methodology may be of value for further studies examining the mechanism of the response.

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