Document Detail

First aid for failing flaps.
MedLine Citation:
PMID:  20571981     Owner:  NLM     Status:  MEDLINE    
Wound coverage with pedicled (local, regional, or distant) or free flaps is commonplace throughout plastic surgery. However, irrespective of the method of tissue transfer or type of tissue being transferred, inflow and outflow remain key parameters for success. Much has been written detailing complex tissue transfers and delineating arterial and venous anatomy. Despite this, simple venous insufficiency causing venous congestion is common. In experimental models, when arterial inflow is impaired, even mild venous inadequacy affects flap survival. Furthermore, studies have shown that venous congestion is more detrimental to the rate and percentage of flap area surviving than arterial ischemia. Obviously, complete venous occlusion typically requires operative exploration and correction, but many instances occur when venous congestion occurs for reasons other than complete venous thrombosis. Here we detail the basic postoperative "first aid" techniques available to optimize venous drainage. Although these techniques are not a substitute for sound anatomic flap selection, good surgical technique, or re-operation when a significant underlying problem exists, they do offer additional options to improve flap outcomes.
Simon G Talbot; Julian J Pribaz
Publication Detail:
Type:  Journal Article; Review     Date:  2010-06-22
Journal Detail:
Title:  Journal of reconstructive microsurgery     Volume:  26     ISSN:  1098-8947     ISO Abbreviation:  J Reconstr Microsurg     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2011-01-13     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  8502670     Medline TA:  J Reconstr Microsurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  513-5     Citation Subset:  IM    
Copyright Information:
© Thieme Medical Publishers.
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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MeSH Terms
First Aid / methods*
Follow-Up Studies
Free Tissue Flaps / blood supply
Graft Rejection / prevention & control*
Heparin / therapeutic use
Hyperemia / etiology,  therapy*
Microsurgery / adverse effects,  methods*
Postoperative Care / methods
Postoperative Complications / diagnosis,  therapy
Reconstructive Surgical Procedures / adverse effects*,  methods
Reoperation / methods
Surgical Flaps / adverse effects,  blood supply*
Tissue and Organ Harvesting
Treatment Outcome
Reg. No./Substance:

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