title: Covering implantable left ventricular assist device (DuraHeart) with free flap.
abstract: Severe donor shortage in Japan makes the waiting period for heart transplantation extremely long and the left ventricular assist devices (LVADs) are often used for bridge-to-transplant. We present three cases of infected and exposed DuraHeart LVAD system treated with free flaps. Four free flaps (two latissimus flaps and two anterolateral thigh flaps) were transferred using the right internal thoracic vessels or left deep inferior epigastric vessels as recipients. The potential significance of the continuous low pressure blood flow generated by the LVAD system on microvascular patency has not been previously reported. All flaps survived and worked efficiently to control the infection and cover the devices. Heart transplantation was conducted in the two of three patients. Free flap transfer is an efficient treatment for the patients with infected and exposed implantable LVAD.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medicine, 1-757, Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan, matsuken@med.niigata-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Matsuda
authors.forename: Akimitsu
authors.initials: A
authors.lastname: Nishibayashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Megumi
authors.initials: M
authors.lastname: Fukai
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
authors.forename: Ko
authors.initials: K
authors.lastname: Hosokawa
mesh_terms: D000328:Adult; D005260:Female; D058752:Free Tissue Flaps; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D013530:Surgical Wound Infection / Q000209:etiology / Q000473:pathology / Q000628:therapy*