There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer...There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.展开更多
Breast reconstruction is one of the largest components of plastic and reconstructive surgery.Autologous free flap breast reconstruction continues to grow due to exceptionally high flap success rates.It provides patien...Breast reconstruction is one of the largest components of plastic and reconstructive surgery.Autologous free flap breast reconstruction continues to grow due to exceptionally high flap success rates.It provides patients with a durable and natural reconstruction with high patient satisfaction.A patent microvascular anastomosis is a key component to a successful autologous free flap breast reconstruction.Thrombus within the vascular anastomosis or the distal flap microcirculation is the most common cause of flap failure.This review aims to discuss microsurgical techniques including atraumatic handling of vessels,appropriate magnification,suture styles,anastomotic techniques,recipient vessel selection,the role of anticoagulation and antiplatelet therapy used to minimize the risk of thrombotic events.When microvascular thrombus occurs,early reoperation and reperfusion is imperative to flap survival.This review will discuss specific maneuvers and intraoperative interventions to maximize flap salvage.展开更多
文摘There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.
文摘Breast reconstruction is one of the largest components of plastic and reconstructive surgery.Autologous free flap breast reconstruction continues to grow due to exceptionally high flap success rates.It provides patients with a durable and natural reconstruction with high patient satisfaction.A patent microvascular anastomosis is a key component to a successful autologous free flap breast reconstruction.Thrombus within the vascular anastomosis or the distal flap microcirculation is the most common cause of flap failure.This review aims to discuss microsurgical techniques including atraumatic handling of vessels,appropriate magnification,suture styles,anastomotic techniques,recipient vessel selection,the role of anticoagulation and antiplatelet therapy used to minimize the risk of thrombotic events.When microvascular thrombus occurs,early reoperation and reperfusion is imperative to flap survival.This review will discuss specific maneuvers and intraoperative interventions to maximize flap salvage.
