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Berkane Y, Cascales JP, Roussakis E, Lellouch AG, Slade J, Bertheuil N, Randolph MA, Cetrulo CL, Evans CL, Uygun K. Continuous oxygen monitoring to enhance ex-vivo organ machine perfusion and reconstructive surgery. Biosens Bioelectron 2024; 262:116549. [PMID: 38971037 DOI: 10.1016/j.bios.2024.116549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
Continuous oxygenation monitoring of machine-perfused organs or transposed autologous tissue is not currently implemented in clinical practice. Oxygenation is a critical parameter that could be used to verify tissue viability and guide corrective interventions, such as perfusion machine parameters or surgical revision. This work presents an innovative technology based on oxygen-sensitive, phosphorescent metalloporphyrin allowing continuous and non-invasive oxygen monitoring of ex-vivo perfused vascularized fasciocutaneous flaps. The method comprises a small, low-energy optical transcutaneous oxygen sensor applied on the flap's skin paddle as well as oxygen sensing devices placed into the tubing. An intermittent perfusion setting was designed to study the response time and accuracy of this technology over a total of 54 perfusion cycles. We further evaluated correlation between the continuous oxygen measurements and gold-standard perfusion viability metrics such as vascular resistance, with good agreement suggesting potential to monitor graft viability at high frequency, opening the possibility to employ feedback control algorithms in the future. This proof-of-concept study opens a range of research and clinical applications in reconstructive surgery and transplantation at a time when perfusion machines undergo rapid clinical adoption with potential to improve outcomes across a variety of surgical procedures and dramatically increase access to transplant medicine.
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Affiliation(s)
- Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; Shriners Children's, Boston, 02114, MA, USA; MOBIDIC, UMR1236, INSERM, Rennes University, Rennes, 35000, France
| | - Juan Pedro Cascales
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA; Departamento de Química en Ciencias Farmacéuticas, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - Emmanuel Roussakis
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Julian Slade
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; MOBIDIC, UMR1236, INSERM, Rennes University, Rennes, 35000, France
| | - Mark A Randolph
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA; Shriners Children's, Boston, 02114, MA, USA
| | - Conor L Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129, MA, USA.
| | - Korkut Uygun
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, 35000, France; Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA.
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2
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Knoedler S, Hoch CC, Huelsboemer L, Knoedler L, Stögner VA, Pomahac B, Kauke-Navarro M, Colen D. Postoperative free flap monitoring in reconstructive surgery-man or machine? Front Surg 2023; 10:1130566. [PMID: 36911625 PMCID: PMC9992807 DOI: 10.3389/fsurg.2023.1130566] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
Free tissue transfer is widely used for the reconstruction of complex tissue defects. The survival of free flaps depends on the patency and integrity of the microvascular anastomosis. Accordingly, the early detection of vascular comprise and prompt intervention are indispensable to increase flap survival rates. Such monitoring strategies are commonly integrated into the perioperative algorithm, with clinical examination still being considered the gold standard for routine free flap monitoring. Despite its widespread acceptance as state of the art, the clinical examination also has its pitfalls, such as the limited applicability in buried flaps and the risk of poor interrater agreement due to inconsistent flap (failure) appearances. To compensate for these shortcomings, a plethora of alternative monitoring tools have been proposed in recent years, each of them with inherent strengths and limitations. Given the ongoing demographic change, the number of older patients requiring free flap reconstruction, e.g., after cancer resection, is rising. Yet, age-related morphologic changes may complicate the free flap evaluation in elderly patients and delay the prompt detection of clinical signs of flap compromise. In this review, we provide an overview of currently available and employed methods for free flap monitoring, with a special focus on elderly patients and how senescence may impact standard free flap monitoring strategies.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
- Correspondence: Samuel Knoedler Martin Kauke-Navarro
| | - Cosima C. Hoch
- Department of Otolaryngology, Head and Neck Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Lioba Huelsboemer
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Viola A. Stögner
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
- Correspondence: Samuel Knoedler Martin Kauke-Navarro
| | - David Colen
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, Yale New Haven Hospital,New Haven, CT, United States
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3
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Trignano E, Tettamanzi M, Rampazzo S, Trignano C, Boccaletti R, Fadda GM, Sanna F, Bussu F, Cossu A, Rubino C. Squamous cell carcinoma of the scalp: a combination of different therapeutic strategies. Case Reports Plast Surg Hand Surg 2023; 10:2210670. [PMID: 37197191 PMCID: PMC10184606 DOI: 10.1080/23320885.2023.2210670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
A case study of a 71-year-old man with a giant cutaneous squamous cell carcinoma of the scalp and calvaria is presented, where a combination of surgical excision, reconstruction with a latissimus dorsi muscular free flap, immunotherapy, and radiotherapy were used to control the disease for two years without recurrence.
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Affiliation(s)
- Emilio Trignano
- Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
- CONTACT Emilio Trignano
| | - Matilde Tettamanzi
- Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
| | - Silvia Rampazzo
- Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
- Silvia Rampazzo Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
| | - Claudia Trignano
- Department of Biomedical Sciences, University of Sassari, Forensic Department, Sassari, Italy
| | | | | | - Fabrizio Sanna
- Institute of Radiological Sciences, University of Sassari, Italy
| | - Francesco Bussu
- Department of Surgical, Microsurgical and Medical Sciences, Otolaryngology Unit, University of Sassari, Sassari, Italy
| | - Antonio Cossu
- Department of Medical, Surgical and Experimental Sciences, Pathology Unit, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Department of Surgical, Microsurgical and Medical Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
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Perforator-based Adipofascial Flaps and ADM: A Novel Combined Approach to Distal Lower Extremity Defects. Plast Reconstr Surg Glob Open 2022; 10:e4131. [PMID: 35198355 PMCID: PMC8856593 DOI: 10.1097/gox.0000000000004131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
Due to the wide spectrum of lower extremity defect presentation, various reconstructive techniques are available. Classic adipofascial flaps are still a second choice. The authors described a new multistage reconstructive approach with perforator-based pedicled adipofascial flap.
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Losco L, Bolletta A, Lo Torto F, Cigna E. Comments on “Partial second‐toe pulp free flap for fingertip reconstruction: Experience and surgical tips to minimize complications” and the use of adipofascial perforator flap for fingertip reconstruction. Microsurgery 2022; 42:296-297. [DOI: 10.1002/micr.30866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/12/2021] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Luigi Losco
- Microsurgery and Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy
| | - Alberto Bolletta
- Microsurgery and Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of Surgery “Pietro Valdoni” Sapienza University of Rome Rome Italy
| | - Emanuele Cigna
- Microsurgery and Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy
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6
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Bolletta A, di Taranto G, Losco L, Elia R, Sert G, Ribuffo D, Cigna E, Chen HC. Combined lymph node transfer and suction-assisted lipectomy in lymphedema treatment: A prospective study. Microsurgery 2022; 42:433-440. [PMID: 34994481 DOI: 10.1002/micr.30855] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent studies have analyzed the combination of suction-assisted lipectomy (SAL) and vascularized lymph node transfer (VLNT) in lymphedema treatment, reporting positive outcomes. However, it is difficult to draw conclusions due to the heterogeneity of the studies. Aim of this prospective study is to evaluate the effectiveness of the combination of VLNT and SAL in lymphedema treatment. PATIENTS AND METHODS Between January 2016 and May 2019, 94 patients with upper or lower limb stage IIb-III lymphedema were enrolled and treated with the gastroepiploic VLNT followed by SAL. Patients were prospectively evaluated through circumference measurement and clinical examination, including number of episodes of cellulitis. RESULTS Among patients enrolled in the study 83 were affected by lower limb lymphedema (LLL) and 11 were affected by upper limb lymphedema (ULL). Average follow-up was 3 ± 0.8 years. In the LLL group, the mean circumference reduction rates (CRR) were 60.4, 56.9, 29.6, and 55.4% above and below the knee, above the ankle, and at the foot level, respectively. A statistically significant difference was noted at all the levels (p < .05), but above the ankle (p = .059). Regarding the ULL group, the mean CRR were 80.7, 60.7, 65.0 and 49.6% above and below the elbow, at wrist and at mid-hand, respectively. CRR were reported at all the levels but no statistical difference was noted. The number of episodes of cellulitis dropped significantly (p < .05). CONCLUSION This study supports the use of VLNT+SAL in lymphedema grades IIb-III, with important implications for the clinical practice.
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Affiliation(s)
- Alberto Bolletta
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe di Taranto
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Plastic Surgery Unit, Department of surgery, Sapienza University of Rome, Italy
| | - Luigi Losco
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rossella Elia
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.,Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Gokhan Sert
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Diego Ribuffo
- Plastic Surgery Unit, Department of surgery, Sapienza University of Rome, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Hung-Chi Chen
- Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
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7
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Halani SH, Hembd AS, Li X, Kirby B, Beard CC, Haddock NT, Suszynski TM. Flap Monitoring Using Transcutaneous Oxygen or Carbon Dioxide Measurements. J Hand Microsurg 2022; 14:10-18. [PMID: 35256823 PMCID: PMC8898164 DOI: 10.1055/s-0040-1718862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Free tissue transfer is a cornerstone of complex reconstruction. In many cases, it represents the last option available for a patient and their reconstruction. At high-volume centers, the risk of free flap failure is low but its occurrence can be devastating. Currently, the mainstay for flap monitoring is the clinical examination. Though reliable when performed by experienced clinicians, the flap exam is largely subjective, is performed discontinuously, and often results in significant time delay between detection of flap compromise and intervention. Among emerging flap monitoring technologies, the most promising appear to be those that rely on noninvasive transcutaneous oxygen and carbon dioxide measurements, which provide information regarding flap perfusion. In this article, we review and summarize the literature on various techniques but primarily emphasizing those technologies that rely on transcutaneous gas measurements. We also define characteristics for the ideal flap monitoring tool and discuss critical barriers, predominantly cost, preventing more widespread utilization of adjunct monitoring technologies, and their implications.
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Affiliation(s)
- Sameer H Halani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Austin S Hembd
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Xingchen Li
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Ben Kirby
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Courtney C Beard
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Nicholas T Haddock
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Thomas M Suszynski
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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8
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Bolletta A, Losco L, Lin J, Oh C, Di Taranto G, Trignano E, Cigna E, Chen HC. Partition of Pectoralis Major Musculocutaneous Flap as a Salvage Procedure for Simultaneous Coverage of the Exposed Carotid Artery and Reconstruction of Cervical Esophagus. Ann Plast Surg 2021; 87:435-439. [PMID: 34270475 DOI: 10.1097/sap.0000000000002895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In advanced pharyngoesophageal cancer patients, a critical event is represented by the failure of primary reconstruction with exposure of the carotid artery and partial or total defect of the cervical esophagus. For these high-risk patients, a partitioned pectoralis major musculocutaneous (PMMC) flap can prevent carotid blowout and provide skin for simultaneous esophageal reconstruction. METHODS Twenty-six patients needing pharyngoesophageal reconstruction together with coverage of carotid artery exposure were included in this retrospective case series. The patients were treated with a partitioned PMMC flap, based on the branching pattern of the pectoral branch of the thoracoacromial artery and the perforators of the pectoralis major muscle, to simultaneously reconstruct the defect and provide coverage for the carotid artery. RESULTS In 25 patients, the partitioned PMMC flap reconstructions resulted in complete wound healing without occurrence of carotid blowout syndrome or fistula formation. Minor complications as partial flap necrosis (7.7%) and strictures formation (7.7%) were recorded but did not compromise reconstruction. Twenty-two patients were able to adopt a semisolid diet, and 4 had recurrence of cancer. CONCLUSIONS The partitioned PMMC flap reconstruction represents a useful salvage solution to simultaneously restore the continuity of the alimentary tract and provide reliable coverage for the exposed carotid artery.
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Affiliation(s)
- Alberto Bolletta
- From the Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Jason Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Christine Oh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Giuseppe Di Taranto
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Umberto I University Hospital, Rome, Italy
| | - Emilio Trignano
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Hung-Chi Chen
- From the Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan
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9
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Noninvasive Monitoring of Deep Tissue Oxygenation in Buried Flaps by Time-Resolved Near-Infrared Spectroscopy in Pigs. Plast Reconstr Surg 2020; 146:565e-577e. [PMID: 33141532 DOI: 10.1097/prs.0000000000007255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Flap monitoring in reconstructive surgery is particularly important because flap failure is a dramatic event for the patient and for the medical team. Noninvasive deep tissue oxygenation monitoring is a challenge. The aim of this experimental study was to assess the performance of time-resolved near-infrared spectroscopy compared with continuous-wave near-infrared spectroscopy and with invasive oxygen partial pressure measurement in pigs. METHODS Thirty fasciocutaneous flaps based on the superficial epigastric inferior pedicle were harvested and buried under the transcutaneous dorsal muscle (approximately 1 cm thick). An optical probe was placed on the skin above each buried flap. For each pig, two buried flaps were performed, one submitted to arterial occlusion and one to venous occlusion. Oxyhemoglobin and deoxyhemoglobin concentrations were observed for over 40 minutes before clamping, almost 20 minutes during clamping and during a period of release of approximately 20 minutes. Variations in time-resolved near-infrared spectroscopy were compared to the oxygen partial pressure and continuous-wave near-infrared spectroscopy variations. RESULTS All vascular events were detected by the time-resolved near-infrared spectroscopy. During arterial clamping, oxyhemoglobin decreased rapidly, whereas deoxyhemoglobin increased moderately. The divergence of oxyhemoglobin and deoxyhemoglobin curves indicated arterial occlusion. During venous clamping, deoxyhemoglobin increased, whereas oxyhemoglobin increased briefly then remained stable or decreased moderately. The initial increases in the oxyhemoglobin and deoxyhemoglobin curves indicated venous occlusion. Oxygen partial pressure failed to detect vascular events in three cases. Continuous-wave near-infrared spectroscopy could not clearly identify vascular occlusions. CONCLUSIONS Thus, the authors demonstrated the relevance of time-resolved near-infrared spectroscopy to buried flap monitoring. Time-resolved near-infrared spectroscopy could differentiate between arterial occlusion and venous occlusion.
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Lartizien R, Besse S, Bettega P, Zaccaria I, Planat-Chrétien A, Berger M, Henry M, Coll JL, Bettega G. Distinction between arterial and venous occlusion with tissue oxygen pressure in a porcine fascio-cutaneous flap model. Microsurgery 2020; 40:881-885. [PMID: 33022827 DOI: 10.1002/micr.30661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND In recent years, many devices have been developed to monitor free flaps. The Licox probe, which measures tissue oxygen pressure (PtO2 ), is one of the available devices. Our aim was to demonstrate that PtO2 could distinguish arterial from venous occlusion in a porcine fascio-cutaneous flap model. MATERIALS AND METHODS Twenty pigs (Sus scrofa domestica, Youna strain, males) were included in this study. The median weight was 87.6 kg (84.6-90.8). Bilateral fascio-cutaneous flaps based on the superficial inferior epigastric pedicle were harvested from each pig. Thirty-eight flaps were analyzed in this study and were monitored by a Licox system during vascular occlusion. The flaps were randomized into two groups according to the clamped vessel: the arterial group (n = 19) and the venous group (n = 19). After a stabilization period of almost 40 min, vascular clamping (arterial or venous) was performed using a microvascular clamp for almost 20 min. The curve profiles were compared between arterial and venous occlusion. RESULTS The inflection point was reached significantly faster in the arterial group: 11 min (9-16) for arterial clamping and 17 min (13-23) for venous clamping (p = .001). A total of 18/19 (95%) pigs in the arterial group and 13/19 (68%) in the venous group (p = .09) reached a level lower than 10 mmHg. The median duration for pressure to drop below 10 mmHg was 9 min (6-12) for arterial clamping and 10 min (9-16) for venous clamping (p = .06). CONCLUSION We showed that PtO2 decreased faster in cases of arterial occlusion than in cases of venous occlusion in a pig model. Based on this observation, it may be possible to distinguish arterial from venous occlusion.
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Affiliation(s)
- Rodolphe Lartizien
- Service de Chirurgie Maxillo-faciale, Centre Hospitalier d'Annecy Genevois, Epagny Metz-Tessy, France.,INSERM-UGA U1209; CNRS UMR5309, Institute for Advanced Biosciences, Grenoble, France
| | - Sanela Besse
- Service de Chirurgie Maxillo-faciale, Centre Hospitalier d'Annecy Genevois, Epagny Metz-Tessy, France
| | - Paul Bettega
- Laboratoire d'économie appliquée de Grenoble, Saint-Martin-d'Hères, France
| | - Isabelle Zaccaria
- Service de Chirurgie Maxillo-faciale, Centre Hospitalier d'Annecy Genevois, Epagny Metz-Tessy, France
| | | | - Michel Berger
- Université Grenoble Alpes, CEA, LETI, DTBS, LS2P, Grenoble, France
| | - Maxime Henry
- INSERM-UGA U1209; CNRS UMR5309, Institute for Advanced Biosciences, Grenoble, France
| | - Jean-Luc Coll
- INSERM-UGA U1209; CNRS UMR5309, Institute for Advanced Biosciences, Grenoble, France
| | - Georges Bettega
- Service de Chirurgie Maxillo-faciale, Centre Hospitalier d'Annecy Genevois, Epagny Metz-Tessy, France.,INSERM-UGA U1209; CNRS UMR5309, Institute for Advanced Biosciences, Grenoble, France
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11
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Losco L, Aksoyler D, Chen S, Bolletta A, Velazquez‐Mujica J, Di Taranto G, Lo Torto F, Marcasciano M, Cigna E, Chen H. Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration. Microsurgery 2020; 40:630-638. [DOI: 10.1002/micr.30623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/05/2020] [Accepted: 06/19/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Luigi Losco
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Dicle Aksoyler
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
| | - Shih‐Heng Chen
- Department of Plastic SurgeryChang Gung Memorial Hospital Taipei Taiwan
| | - Alberto Bolletta
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
| | | | - Giuseppe Di Taranto
- Plastic Surgery Unit, Department of SurgerySapienza University of Rome Rome Italy
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of SurgerySapienza University of Rome Rome Italy
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno Cecina, Piombino ElbaAzienda USL Toscana Nord Ovest Leghorn Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Hung‐Chi Chen
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
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12
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Arnež ZM, Ramella V, Papa G, Novati FC, Manca E, Leuzzi S, Stocco C. Is the LICOX® PtO2system reliable for monitoring of free flaps? Comparison between two cohorts of patients. Microsurgery 2018; 39:423-427. [DOI: 10.1002/micr.30396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Zoran Marij Arnež
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery UnitUniversity of Trieste Trieste Italy
- Plastic Surgery DepartmentOspedale di Cattinara, ASUITs Trieste Italy
| | - Vittorio Ramella
- Plastic Surgery DepartmentOspedale di Cattinara, ASUITs Trieste Italy
| | - Giovanni Papa
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery UnitUniversity of Trieste Trieste Italy
- Plastic Surgery DepartmentOspedale di Cattinara, ASUITs Trieste Italy
| | | | - Elisa Manca
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery UnitUniversity of Trieste Trieste Italy
| | - Sara Leuzzi
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery UnitUniversity of Trieste Trieste Italy
- Plastic Surgery DepartmentOspedale di Cattinara, ASUITs Trieste Italy
| | - Chiara Stocco
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery UnitUniversity of Trieste Trieste Italy
- Plastic Surgery DepartmentOspedale di Cattinara, ASUITs Trieste Italy
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