Principles of Microvascular Surgery.

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Free flaps Free flaps • Failure of free tissue transfers - • Most often due to technical factors. • Khouri, PRS 1998 - » Most of the complications occurred in post traumatic reconstructions. » The magnitude of the traumatic insult is the single most important factor. » One should always seek the vascular pedicle of largest diameter - failures are high when small diameter pedicles are used, especially if ,1mm. 40
• Free groin flap - Free flaps - skin » Superficial circumflex iliac a+v. » Concealment of the donor deformity. » Donor site - closed primarily. » Non hair bearing flap. » Short donor pedicle. » Arterial anomaly's. » Small external diameter 0.8- 1.8mm. » Flap morbidity 15-20%. Free flaps - skin • Free radial forearm flap - » Radial a, cephalic/basilic v. » The most common and versatile skin flap. » Head and neck reconstructions. » Thin flap. » Osseous segment. » Long vascular pedicle, up to 20cm. » Can be sensate flap. » Skin graft to donor site. » Donor site morbidity. 41
Page 1 and 2: Principles of Microvascular Surgery
Page 3 and 4: History • Malt & McKhann, 1962 -
Page 5 and 6: History • Danil & Taylor + O’br
Page 7 and 8: Basic Science Concepts in Microsurg
Page 9 and 10: Vessel Injury and Regeneration •
Page 11 and 12: Vessel Wall Healing • At the time
Page 13 and 14: Damage from needles, sutures and te
Page 15 and 16: The clotting mechanism • Platelet
Page 17 and 18: Antithrombotic therapy Heparin (con
Page 19 and 20: Antithrombotic therapy Low molecula
Page 21 and 22: Antithrombotic therapy conclusions:
Page 23 and 24: The no-reflow effect • Ames, Am J
Page 25 and 26: • Treatment - The no-reflow effec
Page 27 and 28: • Loupes… • Or microscope? Mi
Page 29 and 30: • Key sutures - Anastomotic techn
Page 31 and 32: End-to-end, end-to-side and end-in-
Page 33 and 34: Laser anastomosis • Various exper
Page 35 and 36: Monitoring perfusion • Doppler ul
Page 37 and 38: The influence of patient factors
Page 39: Free flaps • Twenty years ago - f
Page 43 and 44: Free flaps - fascia • Useful wher
Page 45 and 46: Free flaps - muscle • Free latiss
Page 47 and 48: Free fibula flap 47

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