Management of flaps with compromised venous outflow in head and neck microsurgical reconstruction.
Microvascular tissue transfer has become an indispensable procedure for head and neck reconstruction. Although remarkable progress has been made technically, anastomosed vessel occlusion is still a serious complication. Even with technically skilled microsurgeons, anastomosed vessel occlusion occurs because the technique is not the sole prophylaxis against thrombosis in microsurgery. Therefore, to minimize the possibility of an unfavorable result in microsurgery, microsurgeons must be familiar with management options for a vascular compromised flap. Most investigators have agreed that venous obstruction occurs more often than arterial obstruction. Here, we reviewed the published literature on the salvage of venous compromised flaps from the viewpoints of surgical correction, including reanastomosis and catheter thrombectomy, and nonsurgical procedures, such as a medicinal leech, hyperbaric oxygen, and thrombolytic therapy.
Kubo
Tateki
T
Department of Plastic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. tateki@psurg.med.osaka-u.ac.jp
Yano
Kenji
K
Hosokawa
Ko
K
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply*; D014689:Venous Insufficiency / Q000209:etiology* / Q000628:therapy*