Critical time for neovascularization/angiogenesis to allow free flap survival after delayed postoperative anastomotic compromise without surgical intervention: A review of the literature.
Microsurgery
; 36(7): 604-612, 2016 Oct.
Article
en En
| MEDLINE
| ID: mdl-27375230
ABSTRACT
BACKGROUND:
The aim of this study is to determine the minimal postoperative time required that may allow free flap survival after occlusion or ligation of the microsurgical anastomosis without surgical intervention.METHODS:
All reports describing free flap survival and failure after delayed postoperative vascular compromise (after postoperative day 3); including thrombosis and ligation, without revision of the microsurgical anastomoses were reviewed. The type of flap, recipient site, vessel of occlusion, postoperative compromise day, and nonsurgical treatment were analyzed.RESULTS:
22 reports (32 flaps) detailed 16 arterial, 6 venous, and 10 simultaneously arterial and venous (vascular pedicle) compromise in 16 head and neck, 10 lower extremity, 4 breast, and 2 upper extremity free tissue transfers. 12 flaps survived without any intervention, 6 survived with conservative therapy (anticoagulation or leeches), and 14 survived despite pedicle ligation. The range of critical day of occlusion did not differ significantly among vessel types. 75% of arterial compromise occurred between 6 and 15 days. 75% of vascular pedicle compromise occurred between 8.5 and 18 days. When compared to jejunal flaps, skin flaps survived after earlier postoperative occlusion (10.2 vs. 20.8 days; P = 0.01).CONCLUSION:
This analysis suggests that free flaps compromised by vascular thrombosis or pedicle ligation may survive with only conservative therapy when the event occurs after a minimal critical time period. Flap survival is more probable when arterial occlusion or pedicle ligation occurs after postoperative day 12, but this minimal critical period may be as low as 6 days for arterial occlusion. © 2016 Wiley Periodicals, Inc. Microsurgery 36604-612, 2016.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neovascularización Fisiológica
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Procedimientos de Cirugía Plástica
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Colgajos Tisulares Libres
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Oclusión de Injerto Vascular
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Supervivencia de Injerto
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Microcirugia
Tipo de estudio:
Systematic_reviews
Límite:
Humans
Idioma:
En
Año:
2016
Tipo del documento:
Article