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J Reconstr Microsurg 2004; 20(3): 207-213
DOI: 10.1055/s-2004-823108
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Reestablished Circulation After Free Radial Forearm Flap Transfer

Akihiro Ichinose1 , Shinya Tahara1 , Hiroto Terashi1 , Satoshi Yokoo2
  • 1Department of Plastic Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan
  • 2Department of Oral and Maxillofacial Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan
Further Information

Publication History

Accepted: 2 December 2003

Publication Date:
16 April 2004 (online)

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New circulation in the free flap reestablished at the recipient site is the key to successful microvascular reconstructive surgery. This study is the first evaluation of long-term circulatory changes in nine free radial forearm flap transfers. Postoperatively, color Doppler studies revealed that the flow volume through the arterial pedicle increased rapidly during the first 3 days, gradually increased until day 14 (exceeding flow volume through the facial artery of the unoperated contralateral side), then decreased slightly until the sixth month. The pulsatility index, representing vascular resistance downstream, decreased successively. Ohm's law explains that this flow increase is caused by reduced vascular resistance downstream, attributed to changes in the vascularity of the transferred flap and in the recipient bed. The authors believe the circulatory changes are determinants of the clinical properties of the flap. This study addresses the importance of clarifying the events that transpire at the macroscopic circulatory level in the transferred free flap.

KEYWORDS

Reestablished circulation - recipient site - radial forearm flap transfer

REFERENCES

  • 1 Mathes S J, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation.  Plast Reconstr Surg. 1981;  67 177-187
    CrossrefPubMedGoogle Scholar
  • 2 Timmons M J. The vascular basis of the radial forearm flap.  Plast Reconstr Surg. 1986;  77 80-92
    CrossrefPubMedGoogle Scholar
  • 3 Netscher D T, Sharma S, Alford E L, Thornby J, Leibman N S. Superficial versus deep: options in venous drainage of the radial forearm free flap.  Ann Plast Surg. 1996;  36 536-541
    PubMedGoogle Scholar
  • 4 Khashaba A A, McGregor I A. Haemodynamics of the radial forearm flap.  Br J Plast Surg. 1986;  39 441-450
    CrossrefPubMedGoogle Scholar
  • 5 Taylor G I, Palmer J H. The vascular territories (angiosomes) of the body: experimental study and clinical applications.  Br J Plast Surg. 1987;  40 113-141
    CrossrefPubMedGoogle Scholar
  • 6 Salmi A M, Tierala E K, Tukiainen E J, Asko-Seljavaara S L. Blood flow in free muscle flaps measured by color Doppler ultrasonography.  Microsurgery. 1995;  16 666-672
    CrossrefPubMedGoogle Scholar
  • 7 Lorenzetti F, Salmi A, Ahovuo J, Tukiainen E, Asko-Seljavaara S. Postoperative changes in blood flow in free muscle flaps: a prospective study.  Microsurgery. 1999;  19 196-199
    CrossrefPubMedGoogle Scholar
  • 8 Evans G R, Schusterman M A, Kroll S S et al.. The radial forearm free flap for head and neck reconstruction: a review.  Am J Surg. 1994;  168 446-450
    CrossrefPubMedGoogle Scholar
  • 9 Moscoso J F, Urken M L. Radial forearm flaps.  Otolaryngol Clin North Am. 1994;  27 1119-1140
    PubMedGoogle Scholar
  • 10 Swartz W M, Banis J C. Head and Neck Microsurgery. Baltimore; Williams and Wilkins 1992: 36-46
    Google Scholar
  • 11 Soutar D S, McGregor I A. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases.  Plast Reconstr Surg. 1986;  78 1-8
    CrossrefPubMedGoogle Scholar
  • 12 Demirkan F, Wei F C, Lutz B S, Cher T S, Chen I H. Reliability of the venae comitantes in venous drainage of the free radial forearm flaps.  Plast Reconstr Surg. 1998;  102 1544-1548
    CrossrefPubMedGoogle Scholar
  • 13 Benacquista T, Strauch B. Microsurgery. In: Goldwin RM Plastic Surgery. Philadelphia; Lippincott Williams & Wilkins 1999: 205-256
    Google Scholar
  • 14 Ichinose A, Tahara S, Terashi H, Nomura T, Omori M. Short-term postoperative flow changes after free radial forearm flap transfer: possible cause of vascular occlusion.  Ann Plast Surg. 2003;  50 160-164
    CrossrefPubMedGoogle Scholar
  • 15 Sasmor M T, Reus W F, Straker D J, Colen L B. Vascular resistance considerations in free-tissue transfer.  J Reconstr Microsurg. 1992;  8 195-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Lorenzetti F, Suominen S, Tukiainen E et al.. Evaluation of blood flow in free microvascular flaps.  J Reconstr Microsurg. 2001;  17 163-167
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kroll S S, Schusterman M A, Reece G P et al.. Choice of flap and incidence of free flap success.  Plast Reconstr Surg. 1996;  98 459-463
    CrossrefPubMedGoogle Scholar
  • 18 Khouri R K, Cooley B C, Kunselman A R et al.. A prospective study of microvascular free-flap surgery and outcome.  Plast Reconstr Surg. 1998;  102 711-721
    Google Scholar
  • 19 Witzleb E. Functions of the vascular system. In: Schmidt RF, Thews G Human Physiology. Berlin, Heidelberg, New York; Springer-Verlag 1983: 397-455
    Google Scholar
  • 20 Guyton A C, Hall J E. Textbook of Medical Physiology. 10th ed. Philadelphia; WB Saunders 2000: 144-194
    Google Scholar
  • 21 Ciria L G, Gomez C T, Talegon M A. Analysis of flow changes in forearm arteries after raising the radial forearm flap: a prospective study using colour duplex imaging.  Br J Plast Surg. 1999;  52 440-444
    CrossrefPubMedGoogle Scholar
  • 22 Numata T, Iida Y, Shiba K et al.. Usefulness of color Doppler sonography for assessing hemodynamics of free flaps for head and neck reconstruction.  Ann Plast Surg. 2002;  48 607-612
    CrossrefPubMedGoogle Scholar
  • 23 Ichinose A, Tahara S, Terashi H et al.. Importance of the deep vein in the drainage of a radial forearm flap: a haemodynamic study.  Scand J Plast Reconstr Surg Hand Surg. 2003;  37 145-149
    CrossrefPubMedGoogle Scholar
  • 24 Muijsers G J, van Huisseling H, Hasaart T H. The effect of maternal hypoxemia on the umbilical and femoral artery blood flow velocity waveforms and the relationship with mean arterial pressure in fetal sheep.  Gynecol Obstet Invest. 1993;  35 1-6
    PubMedGoogle Scholar
  • 25 O'Brien B M, Morrison W A, Gumley G J. Principles and techniques of microvascular surgery. In: McCarthy JG Plastic Surgery. Philadelphia; WB Saunders 1990: 412-483
    Google Scholar
  • 26 Daniel R K, Kerrigan C L. Principals and physiology of skin flap surgery. In: McCarthy JG Plastic Surgery. Philadelphia; WB Saunders 1990: 275-328
    Google Scholar
  • 27 Taylor G I, Corlett R J, Caddy C M, Zelt R G. An anatomic review of the delay phenomenon: II. Clinical applications.  Plast Reconstr Surg. 1992;  89 408-416 , discussion 417-408
    CrossrefPubMedGoogle Scholar
  • 28 Walkinshaw M, Engrav L, Gottlieb J, Holloway G A. Flow recovery and vasoconstriction following microvascular anastomosis.  Ann Plast Surg. 1988;  20 533-539
    PubMedGoogle Scholar
  • 29 Weinzweig N, Lukash F, Weinzweig J. Topical and systemic calcium channel blockers in the prevention and treatment of microvascular spasm in a rat epigastric island skin flap model.  Ann Plast Surg. 1999;  42 320-326
    CrossrefPubMedGoogle Scholar
  • 30 Sigurdsson G H. Perioperative fluid management in microvascular surgery.  J Reconstr Microsurg. 1995;  11 57-65
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Mason D T, Bartter F C. Autonomic regulation of blood volume.  Anesthesiology. 1968;  29 681-692
    PubMedGoogle Scholar
  • 32 Palmer B, Jurell G, Norberg K A. The blood flow in experimental skin flaps in rats studied by means of the 133 xenon clearance method.  Scand J Plast Reconstr Surg. 1972;  6 6-12
    CrossrefPubMedGoogle Scholar
  • 33 Weinzweig N, Davies B W. Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases.  Plast Reconstr Surg. 1998;  102 1999-2005
    CrossrefPubMedGoogle Scholar
  • 34 Musharafieh R, Osmani O, Musharafieh U, Saghieh S, Atiyeh B. Efficacy of microsurgical free-tissue transfer in chronic osteomyelitis of the leg and foot: review of 22 cases.  J Reconstr Microsurg. 1999;  15 239-244
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Yamamoto Y, Furukawa H, Sugihara T, Fukuda S, Furuta Y, Ryu T. Radial forearm free-flap reconstruction following radiotherapy and total laryngectomy.  J Reconstr Microsurg. 1999;  15 15-18
    PubMedGoogle Scholar
  • 36 Miller S H, Rudolph R. Healing in the irradiated wound.  Clin Plast Surg. 1990;  17 503-508
    PubMedGoogle Scholar
  • 37 Lutz B S, Wei F C, Chen H C, Lin C H, Wei C Y. Reconstruction of scalp defects with free flaps in 30 cases.  Br J Plast Surg. 1998;  51 186-190
    CrossrefPubMedGoogle Scholar
  • 38 Swartz W M, Izquierdo R, Miller M J. Implantable venous Doppler microvascular monitoring: laboratory investigation and clinical results.  Plast Reconstr Surg. 1994;  93 152-163
    CrossrefPubMedGoogle Scholar
  • 39 Kroll S S, Schusterman M A, Reece G P et al.. Timing of pedicle thrombosis and flap loss after free-tissue transfer.  Plast Reconstr Surg. 1996;  98 1230-1233
    CrossrefPubMedGoogle Scholar
  • 40 McKee N H. Operative complications and the management of intraoperative flow failure.  Microsurgery. 1993;  14 158-161
    PubMedGoogle Scholar
  • 41 Taylor G I, Caddy C M, Watterson P A, Crock J G. The venous territories (venosomes) of the human body: experimental study and clinical implications.  Plast Reconstr Surg. 1990;  86 185-213
    CrossrefPubMedGoogle Scholar
  • 42 Johnson P C, Barker J H. Thrombosis and antithrombotic therapy in microvascular surgery.  Clin Plast Surg. 1992;  19 799-807
    PubMedGoogle Scholar

Akihiro IchinoseM.D. Ph.D. 

Department of Plastic Surgery, Kobe University, Graduate School of Medicine

7-5-1, Kusunoki-cho, Chuo-ku

Kobe 650-0017, Japan

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