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Pomares G, Ledoux A, Jager T, Duysens C, Fouasson-Chailloux A. Microsurgery and vasospasms: Spasms' predictive factors during harvesting. Orthop Traumatol Surg Res 2025; 111:103966. [PMID: 39103146 DOI: 10.1016/j.otsr.2024.103966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Vasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited. HYPOTHESIS Our objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses. PATIENTS AND METHODS Primary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer. RESULTS In this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert's classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009). DISCUSSION The occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Germain Pomares
- Institut Européen de la Main, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg
| | - Amandine Ledoux
- Institut Européen de la Main, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg
| | - Thomas Jager
- Institut Européen de la Main, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg
| | - Christophe Duysens
- Institut Européen de la Main, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg
| | - Alban Fouasson-Chailloux
- Institut Européen de la Main, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Médecine Physique et de Réadaptation, CHU Nantes, Nantes Université, 44093 Nantes, France.
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Thomas B, Steinfeldt T, Seyfert U, Megerle K, Bader RD, Radtke C, Hirche C, Bigdeli AK, Kneser U, Gazyakan E, Kiefer J, Behr B. [Perioperative Assessment and Management of Hypercoagulability and Thrombophilia in Microsurgery: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)]. HANDCHIR MIKROCHIR P 2025; 57:92-101. [PMID: 40179942 DOI: 10.1055/a-2535-2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
Uninterrupted blood flow through microsurgically anastomosed vessels is crucial for the postoperative success of reconstructive microsurgery. Contrary to the highly standardized anastomosis techniques, the pivotal partner discipline of evidence-based microsurgical haemostaseology and haemorrheology is still in its infancy. Prospective clinical studies yielding evidence-based recommendations are notably lacking. Currently, perioperative management in microsurgery is based solely on site-specific empirical experience. The collective aim of these diverse efforts is the preoperative identification of increased coagulation (hypercoagulability) or clotting activities (thrombophilia) and the development of relevant anticoagulation strategies. During the 43rd Annual Meeting of the German-Speaking Working Group for Microsurgery (DAM) in November 2022 in Frankfurt, experts in microsurgery, haemostaseology, and anaesthesia deliberated on the fundamentals of coagulation and physiology. Also, alongside a literature review, consensus recommendations for the perioperative management of hypercoagulopathies were established. Subsequently, methodologies were assessed within the panel, criteria for decision-making were gathered, and, ultimately, a consensus recommendation by DAM regarding a perioperative algorithm was devised, which is detailed in this position paper.
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Affiliation(s)
- Benjamin Thomas
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Thorsten Steinfeldt
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Ulrich Seyfert
- Hämostaseologie und Transfusionsmedizin, Institut für Blut Forschung, Saarbrücken, Germany
| | - Kai Megerle
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
| | - Rolf-Dieter Bader
- Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Christine Radtke
- Plastic, Reconstructive and Aesthetic Surgery, Medizinische Universitat Wien, Wien, Austria
| | - Christoph Hirche
- Klinik für Plastische Chirurgie, Hand- und Rekonstruktive Mikrochirurgie, Handtrauma- und Replantationszentrum, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Amir K Bigdeli
- Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Klinikum Kassel GmbH, Kassel, Germany
| | - Ulrich Kneser
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Emre Gazyakan
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jurij Kiefer
- Plastic Surgery, Orlando Health, Orlando, United States
| | - Björn Behr
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, KEM Evang. Kliniken Essen-Mitte gGmbH, Essen, Germany
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Kofoed JS, Tuncer FB, Kwok AC, Agarwal JP, Ruple BA, Borrelli M, Symons JD, Richardson RS, Broxterman RM. Lasting Effects of Surgically Used Topical Vasodilators on DIEP Artery Vascular Function. J Reconstr Microsurg 2025; 41:219-226. [PMID: 39038459 DOI: 10.1055/s-0044-1788326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Surgeons routinely apply papaverine, lidocaine, or verapamil to produce acute vasodilation and prevent vasospasms during microvascular surgeries. There is evidence that topical vasodilators may induce postoperative endothelial and smooth muscle dysfunction, which would present after the acute vasodilatory effects of the topical drugs wear off. Therefore, the purpose of the current study was to evaluate the lasting effects of papaverine, lidocaine, and verapamil on human deep inferior epigastric perforator artery vasodilatory function after the acute effects of the topical drugs had worn off. METHODS Deep inferior epigastric arterial samples were obtained from 12 patients during surgery. Each artery was dissected into four rings which where incubated for 1 minute in either physiological saline solution (control), papaverine (30 mg/mL), lidocaine (20 mg/mL), or verapamil (2.5 mg/mL), followed by a 2-hour washout. Endothelial-dependent and -independent vasorelaxation were then assessed by the isometric tension responses to acetylcholine or sodium nitroprusside, respectively. RESULTS Peak acetylcholine-evoked vasorelaxation (mean ± standard deviation) was not different between control (62 ± 23%) and lidocaine (57 ± 18%, p = 0.881), but was reduced (all p < 0.002) in papaverine (22 ± 27%) and verapamil (22 ± 20%). Peak sodium nitroprusside-evoked vasorelaxation was not different (all p > 0.692) among control (132 ± 35%), lidocaine (121 ± 22%), and verapamil (127 ± 22%), but was less in papaverine (104 ± 41%; p = 0.045) than control. CONCLUSION Surgically used doses of papaverine and verapamil, but not lidocaine, have lasting negative effects on arterial vasodilatory function despite the acute effects of the drugs having worn off. These findings, in conjunction with the spasmolytic properties of each drug, may help guide the selection of an optimal topical vasodilator for use during microvascular surgeries.
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Affiliation(s)
- Jason S Kofoed
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Fatma B Tuncer
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Alvin C Kwok
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | - Bradley A Ruple
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
| | - Marta Borrelli
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - J David Symons
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Division of Endocrinology, Metabolism and Diabetes, Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Russell S Richardson
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
| | - Ryan M Broxterman
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
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Yu JL, Cordero DM, Miller EA. Principles of microvascular surgery in the upper extremity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3647-3659. [PMID: 37875649 DOI: 10.1007/s00590-023-03749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
Upper extremity replantation and microsurgery can be challenging even for the experienced hand and upper extremity surgeon and requires thoughtful consideration and evaluation. This review aims to discuss the general considerations in upper extremity replantation management from the preoperative through the postoperative period.
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Affiliation(s)
- Jenny L Yu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington, 325 9th Ave. Mailstop 359796, Seattle, WA, 98104, USA
| | - Daniella M Cordero
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington, 325 9th Ave. Mailstop 359796, Seattle, WA, 98104, USA
| | - Erin A Miller
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington, 325 9th Ave. Mailstop 359796, Seattle, WA, 98104, USA.
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He J, Lu Y, Chen Y, Peng Y, Zhu Q, Li Z. Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study. J Reconstr Microsurg 2024; 40:496-503. [PMID: 38176431 PMCID: PMC11309803 DOI: 10.1055/a-2238-7798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft. METHODS The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left-right position. RESULTS The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm. CONCLUSION To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left-right position due to anatomical differences.
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Affiliation(s)
- Jiale He
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
- Department of Orthopaedic Surgery, Affiliated Hospital of Xizang Minzu University, Xianyang, Shaanxi, People's Republic of China
| | - Yunxiang Lu
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yuxian Chen
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - You Peng
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qi Zhu
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zhiyong Li
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
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Dastagir N, Obed D, Bucher F, Schmidt JL, Dastagir K, Vogt PM. Vasopressor use in partial flap necrosis in free flap transplant patients with vascular comorbidities: A retrospective study. JPRAS Open 2024; 41:276-284. [PMID: 39286577 PMCID: PMC11403112 DOI: 10.1016/j.jpra.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/30/2024] [Indexed: 09/19/2024] Open
Abstract
Intraoperative use of vasopressors in free flap surgeries is controversially debated. The predominant concern is that pedicle blood supply will decrease leading to post-operative complications. This study examined the role of intraoperative vasopressors, specifically norepinephrine, in free flap partial necrosis based on the patients' comorbidities. We retrospectively analyzed 192 patients who received free flap treatment between 2006 and 2021 and were stratified based on vascular comorbidities. We assessed the role of intraoperative vasopressors using multivariate analysis. Patients who were administered vasopressors did not have a significantly higher risk of partial flap necrosis compared to patients who were not administered vasopressors (OR: 1.439, 95% CI: 0.618-3.348, p=0.399). Upon stratifying by vascular comorbidities, we found that patients with two or more vascular comorbidities who were administered vasopressors had a significantly higher risk of developing flap necrosis (OR: 3.882, 95% CI: 1.266-14.752, p=0.046), indicating that vasopressor use in patients with multiple vascular comorbidities is a risk factor for partial flap necrosis. To minimize the risk of flap marginal necrosis in patients with vascular comorbidities, we recommend limited use of vasopressors or minimizing the flap area to preserve vascularization.
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Affiliation(s)
- Nadjib Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Florian Bucher
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Jana L Schmidt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
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Zhang Y, Chen Y, Wang S, Niu H, Yu H, Luo S. Histopathologic analysis of hyaluronic acid composite solution following intravascular injection: Variability and safety. J Cosmet Dermatol 2023; 22:3241-3245. [PMID: 37430464 DOI: 10.1111/jocd.15881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/29/2023] [Accepted: 06/11/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Although a composite solution of non-crosslinked hyaluronic acid is generally considered safe, few studies have investigated its safety after intravascular injection. METHODS Male Sprague-Dawley rats were administered 0.05 mL of a non-crosslinked hyaluronic acid composite solution via intravascular injection into bilateral inferior epigastric arteries (IEA). Artery samples were obtained at multiple time points for histopathologic analysis. Bilateral abdominal flaps supplied by the IEA were lifted and the same dose of solution was injected into the artery, and flap survival was analyzed. RESULTS Histopathologic analysis showed that the non-crosslinked hyaluronic acid composite solution remained temporarily in the artery lumen following intravascular injection. With continuous blood flow, the filler gradually disintegrated and the artery became recanalized. At 24 h, no filler remained in the lumen. At 7 days after the filler was injected into the IEA feeding the flap, there was no significant difference between the experimental and control groups with respect to flap survival rate. CONCLUSIONS Non-crosslinked hyaluronic acid composite solution is relatively safe when a minimal volume is administered by intravascular injection. The filler will remain in the vessel for a short time, after which the vessel recanalizes.
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Affiliation(s)
- Youliang Zhang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yin Chen
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shiwei Wang
- Department of Medical Department, Imeik Technology Development Co., Ltd., Beijing, China
| | - Huanyun Niu
- Department of Medical Department, Imeik Technology Development Co., Ltd., Beijing, China
| | - Hao Yu
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shengkang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
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Lee DW, Hwang YS, Byeon JY, Kim JH, Choi HJ. Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction? World J Clin Cases 2023; 11:7570-7582. [DOI: 10.12998/wjcc.v11.i31.7570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors.
AIM To evaluate the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).
METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.
RESULTS Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg.
CONCLUSION Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.
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Affiliation(s)
- Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Yong Seon Hwang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
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Yu JW, Chu JJ, Franck P, Polanco TO, Shamsunder MG, Teven CM, Disa JJ, Matros E, Cordeiro PG, Mehrara BJ, Nelson JA, Allen RJ. Outcomes and Perioperative Risk Factors after Oncologic Free-Flap Scalp Reconstruction. J Reconstr Microsurg 2023; 39:565-572. [PMID: 36577500 PMCID: PMC10387503 DOI: 10.1055/a-2004-0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little is known about the risk factors associated with complications after free flap scalp reconstruction. The purpose of this study was to identify patient, scalp defect, and flap characteristics associated with increased risk of surgical complications. METHODS A retrospective study was performed of free-flap scalp reconstruction in oncologic patients at Memorial Sloan Kettering Cancer Center from 2002 to 2017. Data collection included patient, defect, flap, and complication characteristics. Complications were classified into major, defined as complications requiring surgical intervention, and minor, defined as complications requiring conservative treatment. Risk factors and outcome variables were compared using chi-square with Fisher's exact test. RESULTS A total of 63 free flaps to the scalp in 58 patients were performed; average follow-up was 3.5 years. Most flaps were muscle-only or musculocutaneous. One-third of patients with free flaps experienced complications (n = 21, 15 major and 6 minor). Examining risk factors for complications, patients with cardiovascular disease were nearly three times more likely to have suffered a major complication than patients without cardiovascular disease (36.7 vs. 12.1%, p = 0.04). This was the only significant risk factor noted. Perioperative radiotherapy, prior scalp surgery, flap type, and recipient vessel selection were found to be nonsignificant risk factors. CONCLUSION Cardiovascular disease may be a significant marker of risk for major complications in patients undergoing free-flap reconstruction of the scalp. This information should be used to help guide perioperative counseling and decision making in this challenging patient population.
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Affiliation(s)
- Jason W. Yu
- Section of Oral & Maxillofacial Surgery, UCLA School of Dentistry; University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Philipp Franck
- Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Thais O. Polanco
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meghana G. Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Chad M. Teven
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Peter G. Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Babak J. Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Robert J. Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Matsuoka Y, Karakawa R, Yoshimatsu H, Yano T. Postoperative Hematoma-induced Vasospasm after Sarcoma Reconstruction Using a Pedicled Anterolateral Thigh Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5271. [PMID: 37711725 PMCID: PMC10499072 DOI: 10.1097/gox.0000000000005271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 09/16/2023]
Abstract
Hematoma-induced vasospasm is a significant factor that can compromise the success of flap reconstructive surgery. Despite advances in microsurgical techniques and knowledge, vasospasm remains a direct cause of flap loss. Hematoma-induced vasospasm occurs due to the presence of blood breakdown products, which can lead to arterial constriction and reduced blood flow to the transplanted tissue. A 77-year-old man with a history of coronary angina developed soft tissue sarcoma on the right groin. Postoperative hematoma-induced vasospasm occurred subsequent to the reconstruction using a pedicled anterolateral thigh flap for the defect after wide resection. The hematoma was evacuated, and blood flow to the flap was restored with topical application of warm saline and vasodilators. Postoperative administration of intravenous alprostadil was used to counteract the vasospasm, and the flap completely survived without any problems with blood flow. It is important to recognize the triggers of vasospasm, such as hematomas, which may occur intra- or postoperatively, and to take appropriate measures to prevent or treat them. Treatment of vasospasm includes the intraoperative topical application of warm saline or vasodilators and the administration of intravenous alprostadil or 4% lidocaine postoperatively. Nevertheless, in the case of hematoma-induced vasospasm, it is important to remove the hematoma.
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Affiliation(s)
- Yuki Matsuoka
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Karakawa
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Yano
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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11
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Lim BJ, Shin JY, Roh SG, Lee NH, Chung YK. Clinical analysis of factors affecting the failure of free flaps used in head and neck reconstruction. Arch Craniofac Surg 2023; 24:159-166. [PMID: 37654235 PMCID: PMC10475704 DOI: 10.7181/acfs.2023.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Free tissue transfer is the preferred method of reconstructing head and neck defects, with a success rate of approximately 95%. Although flap failure is uncommon, it has a major impact on patient morbidity and diminishes quality of life, making it is important to investigate the causes of flap failure. METHODS This retrospective chart review analyzed patients who underwent free tissue transfer during head and neck reconstruction at a single institution between 2016 and 2021. RESULTS During the study period, 58 patients underwent 60 free flap procedures. Revision surgery was needed in 14 patients. Subsequent free flap surgery was performed in one patient, and three free flaps (5%) could not be salvaged. Cardiovascular disease was significantly associated with flap failure, and venous congestion (thrombosis) was the most common reason for revision surgery. CONCLUSION Cardiovascular disease clearly emerged as a factor related to the failure of free flap surgery, and this issue warrants particular attention in patients for whom free tissue transfer is planned.
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Affiliation(s)
- Beom Jin Lim
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Yoon Kyu Chung
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Seo MG, Kim TG. Mechanical Dilation of the Recipient Vessel with the DeBakey Vascular Dilator in Lower Extremity Reconstruction: A Report of Two Cases. Arch Plast Surg 2023; 50:311-314. [PMID: 37256041 PMCID: PMC10226792 DOI: 10.1055/s-0043-1764309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/13/2023] [Indexed: 06/01/2023] Open
Abstract
In lower extremity reconstruction, the recipient vessel often requires long-range mechanical dilation because of extensive vasospasm or plaque formation induced by concomitant atherosclerosis. While a forceps dilator can be used to manipulate and dilate vessels approximately 1 cm from their end, a DeBakey vascular dilator can dilate long-range vessels. The authors successfully performed free flap reconstruction of the lower extremity using the DeBakey vascular dilator. Of the two patients who underwent lower extremity reconstruction, one had extensive vasospasm, and the other had plaques in the recipient arteries. Irrigation with 4% lidocaine and dilation of the lumen with a forceps dilator were insufficient to restore the normal arterial blood flow. Instead, a DeBakey vascular dilator with a 1-mm diameter tip was gently inserted into the lumen. Then, to overcome vessel resistance, the dilator gently advanced approximately 10 cm to dilate the recipient artery. Normal arterial blood flow was gushed out after dilating the vessel lumen using a DeBakey vascular dilator. The vascular anastomosis was performed, and intravenous heparin 5000 IU was administered immediately after anastomosis. Prophylactic low-molecular-weight-heparin (Clexane, 1 mg/kg) was administered subcutaneously to both patients for 14 days. The reconstructed flap survived without necrosis in either patient.
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Affiliation(s)
- Min-Gi Seo
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Tae-Gon Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
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13
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Regulated extravascular microenvironment via reversible thermosensitive hydrogel for inhibiting calcium influx and vasospasm. Bioact Mater 2023; 21:422-435. [PMID: 36185746 PMCID: PMC9483581 DOI: 10.1016/j.bioactmat.2022.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/18/2022] [Accepted: 08/13/2022] [Indexed: 11/22/2022] Open
Abstract
Arterial vasospasm after microsurgery can cause severe obstruction of blood flow manifested as low tissue temperature, leading to tissue necrosis. The timely discovery and synchronized treatment become pivotal. In this study, a reversible, intelligent, responsive thermosensitive hydrogel system is constructed employing both the gel–sol transition and the sol–gel transition. The “reversible thermosensitive (RTS)” hydrogel loaded with verapamil hydrochloride is designed to dynamically and continuously regulate the extravascular microenvironment by inhibiting extracellular calcium influx. After accurate implantation and following in situ gelation, the RTS hydrogel reverses to the sol state causing massive drug release to inhibit vasospasm when the tissue temperature drops to the predetermined transition temperature. Subsequent restoration of the blood supply alleviates further tissue injury. Before the temperature drops, the RTS hydrogel maintains the gel state as a sustained-release reservoir to prevent vasospasm. The inhibition of calcium influx and vasospasm in vitro and in vivo is demonstrated using vascular smooth muscle cells, mice mesenteric arterial rings, and vascular ultrasonic Doppler detection. Subsequent animal experiments demonstrate that RTS hydrogel can promote tissue survival and alleviate tissue injury responding to temperature change. Therefore, this RTS hydrogel holds therapeutic potential for diseases requiring timely detection of temperature change.
Proposing a new strategy for the discovery and treatment for diseases requiring timely detection of temperature change. Applying both the gel–sol transition and the sol–gel transition of PEG/PLGA triblock polymers. Realizing the dynamical and continuous regulation of the extravascular microenvironment.
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14
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Bas S, Ucak R, Oz K, Karsidag SH. The Effect of Very Low Concentrations of Ethanol on Microvascular Artery and Vein Anastomosis: An Experimental Study. J INVEST SURG 2021; 35:967-977. [PMID: 34521313 DOI: 10.1080/08941939.2021.1974613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study investigated the effect of very low concentrations of ethanol on artery and vein anastomosis. Also, it was aimed to determine the appropriate ethanol concentration to be used in vasospasm. METHODS Rats were divided into five groups of eight rats, each group, as follows: Group i: saline; Group ii: 2.5% ethanol; Group iii: 5% ethanol; Group IV: 7.5% ethanol; and Group V: 10% ethanol. During the femoral artery and vein anastomosis, 1ml of the agent was used for irrigation in each group. Vessel diameters were measured before the anastomosis, at the fifth and 15th minutes, and the third week after the anastomosis. Histopathological samples were taken in the third week. RESULTS In Groups ii and iii, the mean vessel diameters were found to increase 15th minute. Also observed was an increase in mean vessel diameter that continued in the third week. Although acute vasodilation was detected in Groups IV and V, arterial and venous thrombosis was observed in the third week. Intima and media thickness decreased in Group ii, while it increased in Group iii. Perivascular inflammation and fibrosis increased as the ethanol concentration increased. CONCLUSION 2.5% ethanol causes acute and prolonged vasodilation and does not cause endothelial cell damage, perivascular inflammation, and fibrosis. 2.5% ethanol will be a powerful alternative use in many situations that occur with vasospasm.
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Affiliation(s)
- Soysal Bas
- Department of Plastic Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ramazan Ucak
- Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kurtulus Oz
- Department of Plastic Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semra Hacikerim Karsidag
- Department of Plastic Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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15
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A Clampless Technique to Facilitate Successful End-to-End Anastomosis in Small Vessels With Spasm. Ann Vasc Surg 2021; 75:527-530. [PMID: 33915255 DOI: 10.1016/j.avsg.2021.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
End-to-end anastomosis in small arteries can be challenging, especially when the stumps are in spasm after traumatic transection. We describe a novel technique to facilitate such anastomoses under local anesthesia, presenting a 24-year old patient who suffered complete traumatic transection of the left ulnar artery. After having found and prepared the proximal and distal stumps, a soft polyurethane feeding tube (La-med Healthcare, India) and a vein cannula were inserted in the proximal and distal stump, respectively, without using vascular clamps. The manipulation of the catheters offered excellent visualization and widening of the anastomotic line, enabling simultaneous infusion of heparinized saline or vasodilating agents. The anastomosis was completed with no stenosis and pulpable pulses were restored immediately postoperatively. At 1-month follow-up, the Allen test was normal with a normal regular flow of the ulnar artery at duplex ultrasound. The described technique ensures efficient sealing avoiding clamping, casts the small lumens, provides optimal visualization of the anastomotic aspects and prevents stenosis. We believe it should have a place in the surgeon's armamentarium.
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16
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Ogawa H, Kusumoto J, Nomura T, Hashikawa K, Terashi H, Sakakibara S. Wire Myography for Continuous Estimation of the Optimal Concentration of Topical Lidocaine as a Vasodilator in Microsurgery. J Reconstr Microsurg 2021; 37:541-550. [PMID: 33517569 DOI: 10.1055/s-0040-1722759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Intraoperative vasospasm during reconstructive microvascular surgery is often unpredictable and may lead to devastating flap loss. Therefore, various vasodilators are used in reconstructive microsurgery to prevent and relieve vasospasm. Lidocaine is a vasodilator commonly used in microvascular surgery. Although many reports have described its in vitro and in vivo concentration-dependent vasodilatory effects, limited studies have examined the pharmacological effects of lidocaine on blood vessels in terms of persistence and titer. METHODS In this study, the vasodilatory effect of lidocaine was examined by using the wire myograph system. Abdominal aortas were harvested from female rats, sliced into rings of 1-mm thickness, and mounted in the wire myograph system. Next, 10, 5, 2, and 1% lidocaine solutions were applied to the artery, and the change in vasodilation force, persistence of the force, and time required to reach equilibrium were measured. RESULTS The vasodilatory effect was confirmed in all groups following lidocaine treatment. Although strong vasodilation was observed in the 10% lidocaine group, it was accompanied by irreversible degeneration of the artery. Vasodilation in the 1% lidocaine group was weaker than that in the other groups 500 seconds after lidocaine addition (p < 0.05). Between the 5 and 2% lidocaine groups, 5% lidocaine showed a stronger vasodilatory effect 400 to 600 seconds after lidocaine addition (p < 0.01); however, there was no significant difference in these groups after 700 seconds. Additionally, there was no difference in the time required for the relaxation force to reach equilibrium among the 5, 2, and 1% lidocaine groups. CONCLUSION Although our study confirmed the dose-dependent vasodilatory effect of lidocaine, 5% lidocaine showed the best vasodilatory effect and continuity with minimal irreversible changes in the arterial tissue.
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Affiliation(s)
- Haruo Ogawa
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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17
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Rosette J, Garmi R, Boutros M, Sinelnikov M, Bénateau H, Veyssiere A. Letter to the editor: International survey on arterial spasm during free flap surgery. J Plast Reconstr Aesthet Surg 2020; 74:1101-1160. [PMID: 33248940 DOI: 10.1016/j.bjps.2020.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jeanne Rosette
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France.
| | - Rachid Garmi
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France
| | - Mariam Boutros
- Department of Anaesthesiology, Caen University Hospital, 14000 Caen, France
| | | | - Hervé Bénateau
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France; Normandie Université, UNICAEN, BioConnecT, 14000 Caen, France; Medicine Faculty of Caen, University of Caen Basse Normandie, 14032 Caen Cedex 5, France
| | - Alexis Veyssiere
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, 14000 Caen, France; Normandie Université, UNICAEN, BioConnecT, 14000 Caen, France; Medicine Faculty of Caen, University of Caen Basse Normandie, 14032 Caen Cedex 5, France
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18
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Tian J, Chen ZB, Li J. Use of Muscle Feeding Arteries as Recipient Vessels for Soft Tissue Reconstruction in Lower Extremities. Curr Med Sci 2020; 40:739-744. [PMID: 32862385 DOI: 10.1007/s11596-020-2235-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Microsurgical free tissue transfer is still playing an important role in lower extremity reconstruction. Finding a suitable recipient artery for anastomosis is critical in the microsurgical procedure, especially in an extensive wound, or in a complex trauma combined with vascular injury. From April 2014 to March 2018, we retrospectively reviewed patients with traumatic/post-traumatic, oncologic, and electrical wounds in the lower extremity. Those treated with muscle feeding artery as recipient vessels were included. The latissimus dorsi (LD) muscle free flap, anterior lateral thigh (ALT) perforator free flap, and deep inferior epigastric perforator (DIEP) free flap were raised. The muscle feeding arteries to vastus lateral muscle and to medial head of gastrocnemius muscle, concomitant veins, and great saphenous vein were used as recipient vessels. Injuries included in the study were caused by tumour in 2 cases, car accident in 3 cases, crushing in 3 cases, burns in one case, and electrical injury in one case. The wound size varied from 14 cm × 6 cm to 30 cm × 20 cm. LD, ALT, and DIEP free flaps were used in 6, 3, and 4 patients, respectively. The muscle feeding arteries to medial head of gastrocnemius muscle, to sartorius muscle, and to vastus lateral muscle were used as recipient arteries in 4, 5, and one patient, respectively. Concomitant and great saphenous veins were used as recipient veins in 10 and 4 patients, respectively. Using the muscle feeding artery is feasible to avoid injury to the main artery and facilitate dissection and anastomoses, particularly when the wound is located proximal to the mid-third of the lower leg.
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Affiliation(s)
- Jia Tian
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhen-Bing Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jin Li
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Bas S, Hascicek S, Ucak R, Gunenc A, Yesilada AK. Effect of perivascular low dose ethanol on rat femoral vessels: Preliminary study. J Plast Surg Hand Surg 2020; 54:358-364. [PMID: 32643501 DOI: 10.1080/2000656x.2020.1788042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vasospasm is one of the important causes of morbidity in free flap and replantation surgery. In secondary Raynaud's phenomenon, nearly half of the patients experience digital ulceration, pain and loss of function at least once in their lifetime. The aim of this study is to investigate the vasodilation effect of ethanol-mediated chemical denervation on peripheral vessels by topical administration. In this study, 27 Wistar albino male rats weighing 250-300 grams were used. The rats were randomly divided into three groups: saline (group S, n = 8), lidocaine (group L, n = 9) and 96% ethanol (group E, n = 9). According to group, 0.1 mL saline, 0.1 mL lidocaine and 0.1 mL ethanol were applied around the rat femoral neurovascular bundle. After the application, on the 0th day and 3th weeks, femoral artery and vein diameters were measured. After 3. weeks, histopathological samples from femoral artery, vein and nerve were evaluated. On the 0th day, the mean diameter of the femoral artery and vein was similar in group E and L and higher than group S. After three weeks, the vasodilatation effect of ethanol was increased in group E. In Group L and S, the vasodilatation effect was lost. Histopathological examination showed that ethanol significantly caused perivascular inflammation and nerve degeneration compared to other agents and did not cause endothelial damage. Vasodilatation obtained by ethanol is a rapid onset and long-lasting effect. It is also inexpensive and effective for peripheral vasodilatation.
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Affiliation(s)
- Soysal Bas
- Department of Plastic Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seyhan Hascicek
- Department of Pathology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ramazan Ucak
- Department of Pathology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Alican Gunenc
- Department of Plastic Reconstructive and Aesthetic Surgery, Yalova State Hospital, Istanbul, Turkey
| | - Aysin Karasoy Yesilada
- Department of Plastic Reconstructive and Aesthetic Surgery, Medipol University, Istanbul, Turkey
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20
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Ramdass M. Mechanical dilatation of vein graft in vascular anastomosis: how to 'Jimmy' the vessel. Ann R Coll Surg Engl 2020; 102:550-552. [PMID: 32324053 DOI: 10.1308/rcsann.2020.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Ramdass
- Port-of-Spain General Hospital, Trinidad, West Indies
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