title: Free flap rescue using an extracorporeal perfusion device.
abstract: The warm ischaemia time of microvascular free flaps is limited. Incalculable events, such as lack of adequate recipient vessels or intraoperative medical emergencies, can lead to prolonged ischaemia and potentially to flap loss. In this study, critically perfused ischaemic or congested flaps were temporarily perfused with an extracorporeal perfusion system until anastomosis could be commenced. Temporary extracorporeal perfusion was performed in 8 radial forearm flaps for 147 ± 52 (range 77-237) minutes. Flap perfusion was assessed using Indocyanine Green fluorescence angiography and combined laser Doppler flowmetry and remission spectroscopy. Results were compared with those of 30 patients who underwent conventional reconstruction with radial forearm flaps. Flap survival, flap microcirculation, postoperative complications, and hospital stay did not differ between groups. We report successful free flap transfer after short-term extracorporeal perfusion for up to 4 h in 8 patient cases. Temporary extracorporeal free flap perfusion reduces the warm ischaemia time in emergency situations and can help to prevent flap failure in critically perfused or congested flaps. The trial is registered with ClinicalTrials.gov, number NCT02449525.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Fichter
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Ritschl
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rau
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schwarzer
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: von Bomhard
authors.affiliation: Institute for Medical Biometry, Epidemiology and Medical Informatics, Universität des Saarlandes, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany. Electronic address: thomas.muecke@tum.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mücke
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005451:Fluorescein Angiography; D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000628:therapy; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods; D008833:Microcirculation; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery
keywords: Extracorporeal membrane oxygenation; Free tissue flaps; Ischaemia; Microcirculation; Warm ischaemia