Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Use of arterialized saphenous vein venous flow-through flaps

No description
by

Julian Diaz Abele

on 3 June 2016

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Use of arterialized saphenous vein venous flow-through flaps

Use of arterialized venous flow-through flaps as a temporizing measure for hand salvage: A case series
J. Diaz-Abele
Background
Segmental loss
Vascular injury
ø
+
Primary anastomosis
Bypass graft
Contaminated
ø
+
Synthetic or Autologous
+ Immediate closure/ coverage
Versatile but
Higher infection rates, poorer patency rates, need for eventual substitution


Limited donor site
?
Vascular injury + Segmental loss + loss of soft tissue coverage + contamination
Synthetic graft
Readily available
but will need to be exchanged in subacute period given failure and infection rates.
Autologous vein
Better patency rates but risk of desiccation, infection, thrombosis, or blow-out leading to hemorrhage.
*
Hypothesis
Arterialized venous flow-through free flaps are a safe and versatile solution for open wounds with vascular segmental loss.
Same donor site morbidity and availability as vein grafts.
+
Soft tissue barrier protecting the vein from the contaminated/ exposed wound
Proposed approach
Acutely debride and clean wound
+ immediate VFTF to revascularize extremity


Subacutely revise wound (further debridement after demarcation) + deepithelialize VFTF + definitive soft tissue coverage
Acute ischemia + vascular segmental loss + loss of soft tissue coverage + contaminated
Final result
Methods
Retrospective review 2008 - 2015
Upper extremity vascular segmental losses with acute/ sub-acute ischemia treated with immediate VFTF bypass
Results
Four cases identified

All male

Presentation:
Three acute ischemia of the hand
One sub-acute (hand ischemia developed on PAD3)

Mechanism:
Crush/ avulsion injury

Donor:
Distal great saphenous vein used for the four VFTF
Size 3cm wide x 10-18cm long

Inset:
All reversed
Three to proximal and distal radial artery
One to proximal radial artery and superficial palmar arch

Final coverage:
Post injury day three to seven wounds clean and with no further changes in demarcation
VFTF deepithelialized
Three latissimus dorsi musculofasciocutaneous free flaps
One rectus abdominus musculofasciocutaneous free flap
Final outcome
Acutely/ Sub-acutely:
-No infection, or thrombosis
-VFTF had characteristic congestion and epidermolysis
-No loss of pulse on palpation, capillary refill or Doppler signal

Late:
At six month follow-up
-All limbs remained perfused
-All grafts remained patent
-No complications
Conclusion
Arterialized VFTF for limb salvage in segmental vascular loss and open contaminated wounds is a novel technique.

This limited case series is promising.

Further use is needed to have a better understanding of its limitations.


"
?
" = VFTF
Segmental loss
Vascular injury
ø
+
Primary anastomosis
Bypass graft
Contaminated
ø
+
Synthetic or Autologous
+ Immediate closure/ coverage
?
Full transcript