Recipient vessels for free flaps in advanced facial oncologic defects

Abstract Objectives To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. Methods This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher's exact test was used to compare outcomes between the 2 groups. Results On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ± 17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p= 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p= 0.342). Conclusion In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

Reconstructive ladder of the leg without sufficient recipient vessels / 中华显微外科杂志

Objective To establish the reconstructive ladder for the leg without sufficient recipient vessels by case analysis and literature review.Methods From January,2009 to January,2015,772 cases were treated in our center using free flap for leg coverage and 129 cases were found intra-operatively to have insufficient recipient vessels.There were 113 males and 16 females,and the age ranged from 4 to 71 years,averaging 36.5 years.The wounds were post-traumatic (n=108) and non post-traumatic (n=21).The management methods included elongating incision (n=25),vessel transfer(n=22),Flow-through anastomosis(n=17),end-to-side anastomosis (n=13),useing neighboring vessels (n=1S),anastomosis distal to the injured zone (n=14),cross-leg free flap (n=7),and abandoning free flap transfer(n=13).Results Except for the cases of abandoning surgery (n=13,10.1％),there were 86 cases whose flap healed totally (66.7％),9 cases total lost(7.0％),and 11 cases marginal loss (8.5％).It established a reconstructive ladder for this special situation according to the principle of difficulty level.Conclusion The insufficient recipient vessels of the leg were had multi-causes which should be taken account generally before surgery.The optimal protocol for each case should be chosen from the reconstructive ladder based on the technical difficulty level.

Microanastomosis venosa mecánica coupler®: un importante aporte tecnológico a la microcirugía vascular / Coupler® venous mechanic microanastomosis: an important technological contribution to microvascular surgery

Objetivo: El objetivo del presente trabajo es dar a conocer la experiencia de nuestro grupo de Cirugía Plástica, en sutura mecánica microvascular utilizando el dispositivo Coupler® (Synovis Corp, Birmingham, AL) para las anastomosis venosas realizadas en pacientes sometidos microcirugía reconstructiva. Material y Método: Revisión retrospectiva de los últimos 48 colgajos libres operados entre marzo de 2009 y febrero de 2013. Todas las anastomosis microquirúrgicas venosas fueron realizadas con el dispositivo Coupler® y las anastomosis arteriales con sutura separada o continua de nylon 9-0 ó 10-0. Los datos recolectados fueron: datos personales y médicos del paciente, localización del defecto, colgajo utilizado, diámetro de los vasos, anastomosis arterial, Coupler® utilizado, tiempo de anastomosis, complicaciones postoperatorias, trombosis arterial y trombosis venosa. Resultados: Fueron realizados 48 colgajos libres para reconstrucción de extremidad inferior (n = 25, 52,1 por ciento); cabeza-cuello (n = 15, 31 por ciento); mama (n = 5, 10,4 por ciento) y extremidad superior (n = 3, 6,3 por ciento). Los colgajos utilizados fueron: Anterolateral de muslo o ALT (n = 25, 52,1 por ciento), Radial (n = 10, 20,8 por ciento), Perforante de Arteria Epigástrica Inferior o DIEP (n = 5, 10,4 por ciento), Dorsal Ancho (n = 2, 4,2 por ciento), Recto Abdominal (n = 2, 4,2 por ciento), Fíbula (n = 2, 4,2 por ciento), Escápula (n = 1, 2,1), y Gracilis (n = 1, 2,1 por ciento). El diámetro promedio del dispositivo Coupler® utilizado en el total de los casos fue de 2,51 +/- 0,46 mm. El tiempo promedio para la anastomosis venosa fue de 13,5 +/- 7,3 min. Un total de 4 colgajos se perdieron (8,3 por ciento), ninguno a causa de falla venosa. Conclusiones: El Coupler® venoso es un elemento seguro, efectivo y rápido para la realización de las anastomosis microquirúrgicas, es fácil de aprender y su implementación debiese ser considerada en todo centro donde se realice microcirugía.

Aim: The aim of the present paper is to show the experience of the Plastic Surgery Division at the University of Chile Clinical Hospital, with the Coupler® anastomotic device (Synovis Corp, Birmingham, AL) for venous microanastomoses in patients undergoing reconstructive microsurgery. Material and Methods: A retrospective review of 48 consecutive patients with free flaps between March 2009 and in February 2013. All microsurgical venous anastomoses were performed with the Coupler® device and the arterial anastomoses with interrupted or continuous 9-0 or 10-0 nylon sutures. The collected data were: personal and medical patient information, location of the defect, flap used, vessels diameter, arterial anastomoses, Coupler® used, time of anastomosis, postoperative complications, arterial and venous thrombosis. Results: A total of 48 free flaps were performed for reconstruction of lower extremity (n = 25, 52.1%); head-neck (n = 15, 31%); breast (n = 5, 10.4%) and upper extremity (n = 3, 6.3%). The flaps used were: Anterolateral thigh or ALT (n = 25, 52.1%), Radial (n = 10, 20.8%), Deep Inferior Epigastric Artery Perforator or DIEP (n = 5, 10.4%), Latisimus Dorsi (n = 2, 4.2%), Rectus Abdominus (n = 2, 4.2%), Fibula (n = 2, 4.2%), Scapula (n = 1, 2.1%), and Gracilis (n = 1, 2.1%). The Coupler device average diameter used was 2.51 ± 0.46 mm. The average time for the venous anastomosis was 13.5 ± 7.3 minutes. A total of 4 flaps were lost (8.3%), none due to venous thrombosis. Conclusions: The Coupler® System for venous anastomoses is a safe, effective and quick method for microsurgical anastomoses, it is easy to learn and its implementation should be considered in every microvascular surgery center.

Experimental Study of the Histologic Findings of the Neoendothelialization according to Diameter of Polytetrafluoroethylene in Dog / 대한정형외과연구학회지

The purpose of this study was to investigate the patency rates and the histologic findings of neoendothelialization according to the diameter of polytetrafluoroethylene (PTFE) which is the most widely used synthetic graft for blood vessel. Under the operating microscope, grafts of 3 and 5mm in diameter were implanted in both femoral arteries of ten mongrel dogs by interrupted end-to-end microanastomosis. They were divided into two groups according to the diameter of implanted PTFE (3 and 5mm). Each group had five dogs. The lengths of implanted PTFE were 20mm in both groups. All implanted grafts were 25 urn in fibril length and 0.39mm in wall thickness. Two grafts from one dog were harvested at 1, 2, 4, 8, and 12 weeks after implantation and all PTFE grafts were observed for patency rates. The histologic analysis was performed under a light microscope and scanning electron microscope. In conclusion, PTFE with larger diameter than that of recipient vessel is recommended as the grafts for implantation because PTFE is not as elastic as normal vessel.

Experimental Study of the Histologic Findings of the Neoendothelialization according to Length of Polytetrafluoroethylene in Rabbit / 대한정형외과연구학회지

The purpose of this study was to investigate the patency rates and the histologic findings of neoendothelialization according to the length of implanted polytetrafluoroethylene (PTFE) with an internal diameter of 3mm. Under the operating microscope, grafts of 8 and 24mm in length were implanted in the right carotid arteries of thirty rabbits by interrupted end-to-end microanastomosis. They were divided into two groups according to the length of implanted PTFE. Each group had fifteen rabbits. All implanted grafts were 25micro meter in fibril length and 0.39mm in wall thickness. Three grafts per group were harvested at 1, 2, 4, 8, and 12 weeks after implantation and all grafts were observed for patency rates and the histologic findings with a light microscope and scanning electron microscope. In conclusion, there was no difference in patency rates according to the length of implanted PTFE. However, the formation of neointima and subintimal tissue was delayed and incomplete in the longer implanted PTFE group.

The changes of contractibility after microanastomosis of femoral artery in the rat

During the microvascular operation, vasospasm can be disastrous because it may cause necrosis of the flap. But we could not fully understand the pathophysiology of contraction of operated vessels. We performed microvascular anastomosis of the femoral artery in the rats and decided the maximum initia tension and intensity of electrical stimulus. At the site of operation, postoperative 1st, 2nd, 3rd, 5th and 7th days, we took the samples of vessels including microvascular anastomotic site. Using myometry, we observed the responses of the samples responding to the stimuli and compared the results to that of the other unoperated femoral artery. The contractibility of the artery was increased in the first day and remained continuously until the postoperative 7th days.

The Histologic Study of the Neoendothelialization of Polytetrafluoroethylene as an Arterial Substitute in Rabbit / 대한정형외과학회잡지

The purpose of this study was to investigate the patency rates and the histologic findings of neoen- dothelialization according to the length of implanted polytetrafluoroethylene (PTFE) with an internal diameter of 3 mm. Under the operating microscope, grafts of 8 and 24 mm in length were implanted in the right carotid arteries of thirty rabbits by interrupted end-to-end microanastomosis. They were divided into two groups according to the length of implanted PTFE. Each group compised fifteen rabbits. All implanted grafts were 25 pm in fibril length and 0.39 mm in wall thickness. Three grafts per group were harvested at 1, 2, 4, 8, and 12 weeks after implantation respectively and all grafts were observed for patency rates and the histologic findings with light microscope and scanning electron microscope. In conclusion, there was no difference in patency rates according to the length of implanted PTFE and histologically the formation of neointima and subintimal tissue was delayed and incomplete in longer implanted PTFE.