The intrinsic transit time (ITT) describes the

time period from the dye appears at the arterial anastomosis (t1) till it reaches the suture line of the venous anastomosis (t2). As the transit time reflects blood flow velocity within the flap, prolonged ITT might correlate with low blood flow and a higher rate of postoperative thrombosis. We performed a clinical trial evaluating the association between intraoperative free flap transit time and early anastomotic complications in elective microsurgery. Methods: One hundred consecutive patients undergoing elective microsurgical procedures underwent intraoperative ICG angiography (ICGA). In patients with anastomotic patency, angiograms were retrospectively reviewed and the intrinsic transit time was calculated. Postoperative outcome was registered and compared with the ITT. LY294002 concentration AZD4547 order End points included early reexploration surgery and flap loss within the first 24 hours after surgery. Results: Fourteen patients were excluded from the study due to technical anastomotic failure. The overall flap failure rate was 6% (5/86); the incidence of early

re-exploration surgery was 10% (9/86). With a median of 31 seconds patients with an uneventful postoperative course showed significantly shorter ITTs than patients with flap loss or early postoperative reexploration (median: >120 seconds). An optimal cut-off value of ITT > 50 seconds was determined to be strongestly associated with a significantly increased risk of at least one positive end point. Conclusions: This study demonstrates a significant predictive value of the intrinsic flap transit time for the development of flap compromise and early re-exploration TCL surgery. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. “
“Mandibuloacral dysplasia (MAD) is a rare form of inherited lipodystrophy. The type

B pattern is characterized by a generalized absence of subcutaneous tissues. There is also a deficiency of perivascular adiposity that makes the dissection not only of perforators and their source vessels difficult, but the recipient site vasculature as well. Perforator flaps in the MAD patient by definition will never be bulky, and instead a challenge in every respect as the perforators are extremely diminutive and therefore fragile. However, if a large, thin flap with a long pedicle of reasonable caliber is indicated, the attributes of a perforator flap may still be indicated as demonstrated in this case report for a recalcitrant heel pressure sore that had failed the usual conservative medical treatment. © 2013 Wiley Periodicals, Inc. Microsurgery 34:311–313, 2014. “
“This experimental study was designed to investigate and compare the effects of different anesthesia techniques on rat cremaster muscle flap microcirculation. Fifty male Sprague-Dawley rats (130–150 g body weight) were divided into five experimental groups containing ten animals each.