A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study

被引:5
作者
Kagaya, Yu [1 ]
Arikawa, Masaki [1 ]
Akazawa, Satoshi [1 ]
Miyamoto, Shimpei [1 ]
机构
[1] Natl Canc Ctr, Dept Plast & Reconstruct Surg, Tokyo, Japan
关键词
END-TO-SIDE; ANTERIOR THIGH FLAPS; BLOOD-FLOW; RECONSTRUCTION; REVASCULARIZATION; FOOT; RESISTANCE; COVERAGE; SURVIVAL; DEFECTS;
D O I
10.1097/PRS.0000000000008354
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and end-to-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined. Methods: Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state). Results: In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 +/- 14.1 ml/minute versus 6.0 +/- 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 +/- 3.7 versus 13.6 +/- 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values. Conclusion: In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements.
引用
收藏
页码:871 / 881
页数:11
相关论文
共 35 条
[1]   Pulsatility index determination by flowmeter measurement: A new indicator for vascular resistance? [J].
Aleksic, M ;
Heckenkamp, J ;
Gawenda, M ;
Brunkwall, J .
EUROPEAN SURGICAL RESEARCH, 2004, 36 (06) :345-349
[2]   Reconstruction of posttraumatic defects of the foot by flow-through anterolateral or anteromedial thigh flaps with preservation of posterior tibial vessels [J].
Ao, M ;
Nagase, Y ;
Mae, O ;
Namba, Y .
ANNALS OF PLASTIC SURGERY, 1997, 38 (06) :598-603
[3]  
Attinger C., 1997, Oper Tech Plast Reconstr Surg, V4, P183, DOI DOI 10.1016/S1071-0949(97)80025-X
[4]   Secondary delayed venous ischemia in flow-through radial forearm free flaps: A novel treatment technique [J].
Bacakoglu, A ;
Ozkan, MH ;
Muratli, KS ;
Ekin, A .
PLASTIC AND RECONSTRUCTIVE SURGERY, 2002, 110 (02) :552-557
[5]   Rat epigastric flow-through flap as a modulated arteriovenous fistula: Model for the radial artery flow-through flap in distal arterial bypass [J].
Chun, JK ;
Sterry, TP ;
Zhang, WX ;
Wolfeld, MB ;
Silver, L ;
Teodorescu, VJ ;
Marin, ML .
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, 2003, 19 (06) :387-391
[6]   ONE-STAGED COVERAGE AND REVASCULARIZATION OF TRAUMATIZED LIMBS BY A FLOW-THROUGH RADIAL MID-FOREARM FREE FLAP [J].
COSTA, H ;
GUIMARAES, I ;
CARDOSO, A ;
MALTA, A ;
AMARANTE, J ;
GUIMARAES, F .
BRITISH JOURNAL OF PLASTIC SURGERY, 1991, 44 (07) :533-537
[7]   Lateral Thigh Free Flap With Flow-Through Vascular Pedicle [J].
Devansh, Sharma .
ANNALS OF PLASTIC SURGERY, 2011, 67 (01) :44-48
[8]   Flow-through anastomosis for both the artery and vein in leg free flap transfer [J].
Fujiki, Masahide ;
Miyamoto, Shimpei ;
Sakuraba, Minoru .
MICROSURGERY, 2015, 35 (07) :536-540
[9]   Three-Dimensional Computational Modeling of Subject-Specific Cerebrospinal Fluid Flow in the Subarachnoid Space [J].
Gupta, Sumeet ;
Soellinger, Michaela ;
Boesiger, Peter ;
Poulikakos, Dimos ;
Kurtcuoglu, Vartan .
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, 2009, 131 (02)
[10]   Intima-adventitia apposition in end-to-side arterial anastomosis:: An experimental study in the pig [J].
Heijmen, RH ;
Gründeman, PF ;
Borst, C .
ANNALS OF THORACIC SURGERY, 1998, 65 (03) :705-711