Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 63, Issue 7 , Pages 1080-1086 , July 2010

Long term study into surgical re-exploration of the ‘free flap in difficulty’

  • R.I.S. Winterton

      Affiliations

    • Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George Street, Leeds LS1 3EX, UK
    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
    • Corresponding Author InformationCorresponding author. 43 Wike Ridge Avenue, Leeds LS17 9NL, UK. Tel.: +44 7771 801 220.
  • ,
  • R.M. Pinder

      Affiliations

    • Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George Street, Leeds LS1 3EX, UK
    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
  • ,
  • A.N. Morritt

      Affiliations

    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
  • ,
  • S.L. Knight

      Affiliations

    • Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George Street, Leeds LS1 3EX, UK
    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
  • ,
  • A.G. Batchelor

      Affiliations

    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
  • ,
  • M.I. Liddington

      Affiliations

    • Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George Street, Leeds LS1 3EX, UK
    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
  • ,
  • S.P. Kay

      Affiliations

    • Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Great George Street, Leeds LS1 3EX, UK
    • St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK

Received 13 November 2008 ,Accepted 20 May 2009.

References 

  1. Seidenberg B, Rosenak SS, Hurwitt ES, et al. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg. 1959;149:162–171
  2. Panchapakesan V, Addison P, Beausang E, et al. Role of thrombolysis in free-flap salvage. J Reconstr Microsurg. 2003;19:523–530
  3. Yii NW, Evans GR, Miller MJ, et al. Thrombolytic therapy: what is its role in free flap salvage?. Ann Plast Surg. 2001;46:601–604
  4. Nakatsuka T, Harii K, Asato H, et al. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection. J Reconstr Microsurg. 2003;19:363–368[discussion 69]
  5. Khouri RK, Cooley BC, Kunselman AR, et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg. 1998;102:711–721
  6. Kroll SS, Schusterman MA, Reece GP, et al. Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg. 1996;98:1230–1233
  7. Bui DT, Cordeiro PG, Hu QY, et al. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg. 2007;119:2092–2100
  8. Chen KT, Mardini S, Chuang DC, et al. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg. 2007;120:187–195
  9. Hidalgo DA, Disa JJ, Cordeiro PG, et al. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg. 1998;102:722–732[discussion 33–4]
  10. Kroll SS, Schusterman MA, Reece GP, et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg. 1996;98:459–463
  11. Disa JJ, Cordeiro PG, Hidalgo DA. Efficacy of conventional monitoring techniques in free tissue transfer: an 11-year experience in 750 consecutive cases. Plast Reconstr Surg. 1999;104:97–101
  12. de la Torre J, Hedden W, Grant JH, et al. Retrospective review of the internal Doppler probe for intra- and postoperative microvascular surveillance. J Reconstr Microsurg. 2003;19:287–290
  13. Yajima H, Tamai S, Mizumoto S, et al. Vascular complications of vascularized composite tissue transfer: outcome and salvage techniques. Microsurgery. 1993;14:473–478
  14. Wei FC, Demirkan F, Chen HC, et al. The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?. Plast Reconstr Surg. 2001;108:1154–1160[discussion 61–2]
  15. Chaivanichsiri P. Influence of recipient vessels on free tissue transplantation of the extremities. Plast Reconstr Surg. 1999;104:970–975
  16. Shaw WW, Ko CY, Ahn CY, et al. Safe ischemia time in free-flap surgery: a clinical study of contact-surface cooling. J Reconstr Microsurg. 1996;12:421–424
  17. Jallali N, Ridha H, Butler PE. Postoperative monitoring of free flaps in UK plastic surgery units. Microsurgery. 2005;25:469–472
  18. Whitaker IS, Gulati V, Ross GL, et al. Variations in the postoperative management of free tissue transfers to the head and neck in the United Kingdom. Br J Oral Maxillofac Surg. 2007;45:16–18
  19. Kay S, Coady M. The role of microsurgery and free tissue transfer in the reconstruction of the paediatric upper extremity. Ann Acad Med Singap. 1995;24:113–123
  20. Kay SP, Wiberg M. Toe to hand transfer in children. Part 1: technical aspects. J Hand Surg [Br]. 1996;21:723–734
  21. Serletti JM, Schingo VA, Deuber MA, et al. Free tissue transfer in pediatric patients. Ann Plast Surg. 1996;36:561–568
  22. Heller L, Levin LS, Klitzman B. Laser Doppler flowmeter monitoring of free-tissue transfers: blood flow in normal and complicated cases. Plast Reconstr Surg. 2001;107:1739–1745
  23. Hirigoyen MB, Blackwell KE, Zhang WX, et al. Continuous tissue oxygen tension measurement as a monitor of free-flap viability. Plast Reconstr Surg. 1997;99:763–773
  24. Irwin MS, Thorniley MS, Dore CJ, et al. Near infra-red spectroscopy: a non-invasive monitor of perfusion and oxygenation within the microcirculation of limbs and flaps. Br J Plast Surg. 1995;48:14–22
  25. Udesen A, Lontoft E, Kristensen SR. Monitoring of free TRAM flaps with microdialysis. J Reconstr Microsurg. 2000;16:101–106
  26. Jyranki J, Suominen S, Vuola J, et al. Microdialysis in clinical practice: monitoring intraoral free flaps. Ann Plast Surg. 2006;56:387–393
  27. Top H, Sarikaya A, Aygit AC, et al. Review of monitoring free muscle flap transfers in reconstructive surgery: role of 99mTc sestamibi scintigraphy. Nucl Med Commun. 2006;27:91–98
  28. Pryor SG, Moore EJ, Kasperbauer JL. Implantable Doppler flow system: experience with 24 microvascular free-flap operations. Otolaryngol Head Neck Surg. 2006;135:714–718
  29. Futran ND, Stack BC, Hollenbeak C, et al. Green light photoplethysmography monitoring of free flaps. Arch Otolaryngol Head Neck Surg. 2000;126:659–662
  30. Wilson R, Yates A. Paediatric microvascular surgery: anaesthetic experience of 27 toe to hand transfers. Paediatr Anaesth. 1993;3:209–215
  31. Jones I, Kelly M, Percival N. Clinical monitoring of free flaps in the UK. Br J Plast Surg. 1999;52:78–79
  32. Pellini R, Pichi B, Ruggieri M, et al. Venous flow-through flap as an external monitor for buried radial forearm free flap in head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2006;59:1217–1221
  33. Yang JC, Kuo YR, Hsieh CH, et al. The use of radial vessel stump in free radial forearm flap as flap monitor in head and neck reconstruction. Ann Plast Surg. 2007;59:378–381
  34. Yuen JC. Techniques of external monitoring of buried free flaps. Ann Plast Surg. 2005;55:460–465
  35. Brown JS, Devine JC, Magennis P, et al. Factors that influence the outcome of salvage in free tissue transfer. Br J Oral Maxillofac Surg. 2003;41:16–20
  36. Devine JC, Potter LA, Magennis P, et al. Flap monitoring after head and neck reconstruction: evaluating an observation protocol. J Wound Care. 2001;10:525–529
  37. Hui KC, Zhang F, Shaw WW, et al. Assessment of the patency of microvascular venous anastomosis. J Reconstr Microsurg. 2002;18:111–114
  38. Zeebregts C, Acosta R, Bolander L, et al. Clinical experience with non-penetrating vascular clips in free-flap reconstructions. Br J Plast Surg. 2002;55:105–110
  39. Salgado CJ, Smith A, Kim S, et al. Effects of late loss of arterial inflow on free flap survival. J Reconstr Microsurg. 2002;18:579–584
  40. Kerrigan CL, Wizman P, Hjortdal VE, et al. Global flap ischemia: a comparison of arterial versus venous etiology. Plast Reconstr Surg. 1994;93:1485–1495[discussion 96–7]
  41. Devaraj VS, Kay SP, Batchelor AG, et al. Microvascular surgery in children. Br J Plast Surg. 1991;44:276–280
  42. Hidalgo DA, Jones CS. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases. Plast Reconstr Surg. 1990;86:492–498[discussion 99–501]

 Previously presented: This work was presented as an oral presentation at the BAPRAS Winter Meeting 2006 (The Royal College of Surgeons of England, London) and was awarded the 2006 York Medical Technologies/Heinz Waldrich Microsurgical Prize for best Oral Presentation Regarding Microsurgery.

PII: S1748-6815(09)00411-2

doi: 10.1016/j.bjps.2009.05.029

Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 63, Issue 7 , Pages 1080-1086 , July 2010