The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses.

INTRODUCTION: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. METHODS: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. RESULTS: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. CONCLUSIONS: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two.

An Experimental Lymphedema Animal Model for Assessing the Results of Lymphovenous Anastomosis.

BACKGROUND: The lymphatic system is the least studied of the body's systems, and as a result its contribution to human health and diseases is not well known. The failure of the lymphatic system to drain extravasated fluid efficiently leads to accumulation of lymph in the interstitial tissue, thus causing lymphedema. Despite developments in microsurgery procedures, the results of lymphedema treatment remain disappointing. The aim of this study was to develop an experimental animal model that is able to reproduce the disease and to apply various surgical and therapeutic approaches. METHODS AND RESULTS: Lymphedema was induced in New Zealand white rabbits by a total skin denudation and destruction of the lymph channels via microsurgery in the right ear, leaving the left ear as control. Lymphedema generation was observed between days 7 and 15 after intervention. On day 15, a terminal venous lymphatic anastomosis was performed on the posterior edge of the right ear. Serial measurements of ear thickness were made during the study. Ear thickness was significantly (p < 0.05) increased after lymphedema induction compared to baseline (3.2 ± 0.4 vs. 1.3 ± 0.04 mm). After anastomosis, ear thickness was reduced (2 ± 0.26 mm). CONCLUSION: This animal model of lymphedema induction in the ear proved to be a reproducible alternative for studying new approaches to lymphedema treatment and for developing microsurgical skills.

Chimeric Superficial Circumflex Iliac Perforator Flap Including External Oblique Fascia: A Refinement of Conventional Harvesting.

The superficial circumflex iliac perforator (SCIP) flap is one of the most suitable flaps to cover distal extremity defects due to its lack of bulkiness and donor site concealment. However, it is less popular than other perforator flaps due to its anatomical variations, short pedicle length, and small caliber vessels. We describe a novel design for the SCIP flap, consisting of a chimeric flap with a piece of the external oblique muscle fascia. The purpose of this design is to cover and protect the vascular anastomosis in distal lower limb defects where recipient vessels are superficial and skin coverage is poor. In addition, lengthening the pedicle with this design makes the flap more versatile. The addition of a cuff of fascia in harvesting of the SCIP flap lengthens the pedicle, allowing easier insetting of the skin paddle and providing complete protection and coverage of the vessels. This procedure allows greater versatility in inset of the skin paddle and is particularly suitable in cases where recipient vessels are superficial or when skin coverage is poor.