Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Mechanical Dilation of the Recipient Vessel with the DeBakey Vascular Dilator in Lower Extremity Reconstruction: A Report of Two Cases

  • Min-Gi Seo (Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Tae-Gon Kim (Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University)
  • Received : 2022.10.26
  • Accepted : 2023.01.13
  • Published : 2023.05.15
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Abstract

In lower extremity reconstruction, the recipient vessel often requires long-range mechanical dilation because of extensive vasospasm or plaque formation induced by concomitant atherosclerosis. While a forceps dilator can be used to manipulate and dilate vessels approximately 1 cm from their end, a DeBakey vascular dilator can dilate long-range vessels. The authors successfully performed free flap reconstruction of the lower extremity using the DeBakey vascular dilator. Of the two patients who underwent lower extremity reconstruction, one had extensive vasospasm, and the other had plaques in the recipient arteries. Irrigation with 4% lidocaine and dilation of the lumen with a forceps dilator were insufficient to restore the normal arterial blood flow. Instead, a DeBakey vascular dilator with a 1-mm diameter tip was gently inserted into the lumen. Then, to overcome vessel resistance, the dilator gently advanced approximately 10 cm to dilate the recipient artery. Normal arterial blood flow was gushed out after dilating the vessel lumen using a DeBakey vascular dilator. The vascular anastomosis was performed, and intravenous heparin 5000 IU was administered immediately after anastomosis. Prophylactic low-molecular-weight-heparin (Clexane, 1 mg/kg) was administered subcutaneously to both patients for 14 days. The reconstructed flap survived without necrosis in either patient.

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References

  1. Pu LLQ. Free flaps in lower extremity reconstruction. Clin Plast Surg 2021;48(02):201-214
  2. Jang YJ, Park MC, Hong YS, et al. Successful lower extremity salvage with free flap after endovascular angioplasty in peripheral arterial occlusive disease. J Plast Reconstr Aesthet Surg 2014;67 (08):1136-1143 https://doi.org/10.1016/j.bjps.2014.04.021
  3. Vargas CR, Iorio ML, Lee BT. A systematic review of topical vasodilators for the treatment of intraoperative vasospasm in reconstructive microsurgery. Plast Reconstr Surg 2015;136(02):411-422 https://doi.org/10.1097/PRS.0000000000001431
  4. Fila B. The advantages of using vascular dilators in angioaccess surgery. Blood Purif 2020;49(06):647-651 https://doi.org/10.1159/000506503
  5. Loop FD, Effler DB, Spampinato N, Groves LK, Cheanvechai C. Myocardial revascularization by internal mammary artery grafts. A technique without optical assistance. J Thorac Cardiovasc Surg 1972;63(04):674-680 https://doi.org/10.1016/S0022-5223(19)41886-2
  6. Hahn HM, Cha B, Lee IJ. The retrograde limb of the internal mammary artery: an alternative inflow option for free flap breast reconstruction. Arch Hand Microsurg 2020;25:326-330 https://doi.org/10.12790/ahm.20.0074
  7. Turin SY, Walton RL, Dumanian GA, Hijjawi JB, LoGiudice JA, Alghoul M. Current practices in the management of postoperative arterial vasospasm in microsurgery. J Reconstr Microsurg 2018;34(04):242-249 https://doi.org/10.1055/s-0037-1612601
  8. Kapilan G, Arudchelvam J. Post-traumatic lower limb arterial spasm: a common entity and an important cause for diagnostic dilemma: a case series. Ann Short Reports. 2020;3:1057
  9. Cavadas PC, Vera-Sempere FJ. Experimental free tissue transfer over perivascular-injured vessels: effect of in vivo freezing. Microsurgery 1996;17(06):295-300 https://doi.org/10.1002/(SICI)1098-2752(1996)17:6<295::AID-MICR2>3.0.CO;2-H
  10. Bayat A. A novel irrigating vessel dilator for microsurgery. Plast Reconstr Surg 2001;108(03):797-798 https://doi.org/10.1097/00006534-200109010-00044
  11. Pafitanis G, Kyprianou K, Chen HC. Microvascular anastomosis in atherosclerotic vessels: technical challenges and recommendations. J Plast Reconstr Aesthet Surg 2021;74(07):1633-1701 https://doi.org/10.1016/j.bjps.2020.12.075
  12. Kaciulyte J, Losco L, Maruccia M, et al. Postsurgical antithrombotic therapy in microsurgery: our protocol and literature review. Eur Rev Med Pharmacol Sci 2019;23(10):4448-4457
  13. Yousef MA, Dionigi P. Experimental thromboprophylaxis with low molecular weight heparin after microsurgical revascularization. J Hand Microsurg 2015;7(02):256-260 https://doi.org/10.1007/s12593-015-0196-0