Free flap transplantation using an extracorporeal perfusion device: First three cases

详细信息    查看全文

• 作者：Klaus-Dietrich Wolff^a ; Thomas Mü ; cke^a ; Achim von Bomhard^a ; Lucas M. Ritschl^a ; Jü ; rgen Schneider^b ; Martin Humbs^a ; Andreas M. Fichter^a ; ^{andreas.fichter@tum.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Microvascular free flap ; Reconstructive surgery ; Vessel-depleted neck ; Extracorporeal perfusion
• 刊名：Journal of Cranio-Maxillofacial Surgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：44
• 期：2
• 页码：148-154
• 全文大小：1849 K

文摘

Free flap transplantation may not be feasible in patients with inadequate or absent recipient vessels. We report successful mandibular composite reconstructions without anastomosis in three consecutive patients with vessel-depleted neck. Based on clinical reports describing early neovascularisation, temporary extracorporeal perfusion of flaps was maintained until the flaps had become independent from the extracorporeal blood supply.

Methods

A blood transfusion bag filled with the patients' arterialised blood was connected to the flap artery and set under rhythmic compression to ensure continuous blood supply to the flap. The returning venous blood was collected but not reinfused. Extracorporeal circulation was sustained for 10–13 days until flaps had become independent from the external blood supply. Flap viability was assessed every 2 h using combined laser Doppler flowmetry and remission spectroscopy.

Results

Successful bony reconstructions were achieved in all three consecutive patients substantiated by MRI-, CT-scan or bone scintigraphy. Neovascularisation occurred within the soft tissues of all flaps with the exception of one skin paddle, which later developed necrosis. Systemic transfusion of 12–25 units of packed red cells was necessary to compensate for the blood loss.

Conclusions

With this technique, transplantation of composite free flaps becomes feasible even in the absence of recipient vessels, opening up new treatment options to a broad range of complex surgical problems. Blood reinfusion should be pursued in the future to avoid excessive blood transfusions. The trial is registered with ClinicalTrials.gov, number NCT02449525.