FPRS microvascular free flaps Flashcards
What are vessels leaving the axial blood supply of a
free flap and passing through muscle on their way
to supply the skin called?
Musculocutaneous perforators
Review the clinical findings of acute arterial
thrombosis of a free flap in the early postoperative
period.
Loss of implanted Doppler signal (if placed); the flap is cool, pale, and without capillary refill, and there is no bleeding
after pinprick.
A free-flap arterial anastomosis is revised within
the first 24 hours after surgery for presumed
arterial thrombosis. Despite good blood flow through the artery after the revision, the flap’s
appearance at the skin level does not improve; subsequently, it undergoes necrosis. What is the most likely reason for failure after revision surgery
despite good blood flow through the artery?
No-reflow phenomenon: Despite restoration of blood flow through the major artery, the prior occlusion and ischemia have detrimental effects on the microvasculature, which caused subsequent necrosis.
Review the clinical findings of venous congestion
of a free flap in the early postoperative period.
Congestion and edema, violaceous color with brisk bleeding
of dark blood on pinprick, loss of venous Doppler signal
What is the most common reason for venous
occlusion of a free-flap vascular pedicle?
Mechanical obstruction from compression, twisting, or
kinking
What nonsurgical therapy can be used to treat venous congestion after free-flap reconstruction?
Leech therapy
What is the most common free flap used for reconstruction of hemi-glossectomy defects?
Radial forearm free flap
Describe the Allen test.
The patient makes a fist and elevates the hand. The radial
and ulnar arteries are compressed. The hand is then opened
and should appear blanched. Pressure is released from the
ulnar artery. The hand should have capillary refill and return
to a normal color in 5 to 7 seconds, indicating a patent
ulnar artery and palmar arches.
What is the vascular supply to an osteocutaneous
radial forearm free flap?
Perforators from the radial artery
What nerves provide sensory innervation to the fasciocutaneous paddle of the osteocutaneous
radial forearm free flap?
The medial and lateral antebrachial cutaneous nerves
What added complication can occur when using an osteocutaneous radial forearm free flap as opposed to a fasciocutaneous radial forearm free flap?
Pathologic fracture of the radius
What are some of the potential donor site
complications of an osteocutaneous radial forearm free flap?
Incomplete skin graft take, radius fracture, hand and forearm weakness and contracture, numbness, and hematoma
What are some potential donor sites for osseocutaneous free tissue transfer for reconstruction of segmental mandibular defects?
Fibula, radius, scapula, iliac crest
Which osteocutaneous free flaps can accept dental implants?
Iliac crest and fibula. The scapula has a variable ability to accept dental implants.
Review relative candidacy requirements for osseointegrated dental implant placement?
Absence of poorly controlled autoimmune or all vessel disease, which could impair healing; no trismus; good tongue mobility; adequate bone stock
Describe the difference between segmental and marginal mandibulectomy.
In a segmental mandibulectomy, the entire vertical height of a portion of the mandible is removed. In a marginal mandibulectomy, at least 1 cm of the inferior border remains in continuity.
Review the general options for segmental mandibular defect reconstruction?
Reconstruction with hardware alone (large reconstruction
bar for lateral defects), hardware combined with a local flap (large reconstruction bar with pectoralis muscle), hardware
combined with free tissue transfer
What are the reconstructive goals when repairing
a segmental mandibulectomy defect?
Maintenance of occlusion, restoration of bone continuity, oral competence, maintenance of facial symmetry, and ability to place a dental prosthesis
What are the major disadvantages to the use of a reconstruction plate alone for reconstruction of a segmental mandibulectomy defect?
Plate extrusion, plate fracture, development of mandible osteomyelitis
What is the vascular supply to the osteocutaneous
fibular free flap?
The peroneal artery and the paired venae comitantes
What is the most effective test to evaluate the lower extremities for adequate vasculature prior to fibula free flap harvest?
CT angiogram with three-vessel runoff of the lower extremities. Angiography is probably the gold standard but has largely been replaced by CT angiography.
What are some of the potential donor site
complications of an osteocutaneous fibular free flap?
Compartment syndrome, peroneal nerve weakness, hematoma, decreased range of motion, ankle instability, and foot ischemia
What is the vascular supply to the osteocutaneous
scapular free flap?
Circumflex scapular branch of the subscapular artery
What are some of the potential complications of an osteocutaneous scapular free flap?
Potential donor-site complications include long thoracic nerve injury, winged scapula, uppe-extremity weakness
and decreased range of motion, wound dehiscence,
hematoma, and seroma. Potential recipient-site defects include hematoma and flap necrosis.
What is the most common type of perforating vessels encountered in the anterolateral thigh free flap?
Myocutaneous perforators
The anterolateral thigh free flap is based on what
artery?
Descending branch of the lateral femoral circumflex artery
The rectus abdominis free flap is based on what artery?
Deep inferior epigastric artery
The latissimus dorsi free flap is based on what artery?
Thoracodorsal artery from the subscapular system
What donor site nerve is used for neurorrhaphy
when the gracilis free flap is used for facial
reanimation?
The obturator nerve
