New Insight into an Old Paradigm: Wrapping and Dangling with Lower-Extremity Free Flaps
ABSTRACT Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is exam...
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| Veröffentlicht in: | Journal of reconstructive microsurgery 2010-10, Vol.26 (8), p.559-566 |
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| container_title | Journal of reconstructive microsurgery |
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| creator | Ridgway, Emily B Kutz, Richard H Cooper, Jason S Guo, Lifei |
| description | ABSTRACT
Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is examined as measured by ViOptix with wrapping and unwrapping during dangling at different postoperative time points. The results are compared with the nonaffected lower extremity and additional healthy controls. Upon dangling a reconstructed lower extremity, the tissue oximetry recording of a free flap descended rapidly until the leg was reelevated and then continued at this low level with a gradual return to the predangling baseline. The extent of this drop in tissue oxygenation depended upon positioning, and the length of time to reach its baseline upon reelevation decreased as flap matured postoperatively. In addition, wrapping of a reconstructed lower extremity also decreased the overall drop in tissue oxygenation level and the time to recovery while having no effect on the control. Results of this prospective study can lead to an increased understanding of free flap physiology in lower-extremity reconstruction and can further validate and refine our postoperative management strategies regarding dependency and edema control. |
| doi_str_mv | 10.1055/s-0030-1263292 |
| format | Article |
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Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is examined as measured by ViOptix with wrapping and unwrapping during dangling at different postoperative time points. The results are compared with the nonaffected lower extremity and additional healthy controls. Upon dangling a reconstructed lower extremity, the tissue oximetry recording of a free flap descended rapidly until the leg was reelevated and then continued at this low level with a gradual return to the predangling baseline. The extent of this drop in tissue oxygenation depended upon positioning, and the length of time to reach its baseline upon reelevation decreased as flap matured postoperatively. In addition, wrapping of a reconstructed lower extremity also decreased the overall drop in tissue oxygenation level and the time to recovery while having no effect on the control. Results of this prospective study can lead to an increased understanding of free flap physiology in lower-extremity reconstruction and can further validate and refine our postoperative management strategies regarding dependency and edema control.</description><identifier>ISSN: 0743-684X</identifier><identifier>EISSN: 1098-8947</identifier><identifier>DOI: 10.1055/s-0030-1263292</identifier><identifier>PMID: 20703988</identifier><identifier>CODEN: JRMIE2</identifier><language>eng</language><publisher>New York, NY: Thieme</publisher><subject>Adult ; Bandages ; Biological and medical sciences ; Edema - prevention & control ; Exercise Therapy - methods ; Female ; Follow-Up Studies ; Free Tissue Flaps - blood supply ; General aspects ; Graft Rejection - prevention & control ; Graft Survival ; Humans ; Injury Severity Score ; Leg Injuries - diagnosis ; Leg Injuries - surgery ; Male ; Medical sciences ; Microsurgery - methods ; Movement ; Oximetry ; Oxygen Consumption - physiology ; Postoperative Care - methods ; Posture ; Prospective Studies ; Reconstructive Surgical Procedures - methods ; Reconstructive Surgical Procedures - rehabilitation ; Regional Blood Flow ; Risk Assessment ; Treatment Outcome ; Wound Healing - physiology ; Young Adult</subject><ispartof>Journal of reconstructive microsurgery, 2010-10, Vol.26 (8), p.559-566</ispartof><rights>Thieme Medical Publishers</rights><rights>2015 INIST-CNRS</rights><rights>Thieme Medical Publishers.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-e1f1d9506cb25635077da707255534b293b12ae12a270c3a2b2f679a8ce3f5c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0030-1263292.pdf$$EPDF$$P50$$Gthieme$$H</linktopdf><linktohtml>$$Uhttps://www.thieme-connect.de/products/ejournals/html/10.1055/s-0030-1263292$$EHTML$$P50$$Gthieme$$H</linktohtml><link.rule.ids>314,780,784,3015,3016,27923,27924,54558,54559</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23293336$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20703988$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ridgway, Emily B</creatorcontrib><creatorcontrib>Kutz, Richard H</creatorcontrib><creatorcontrib>Cooper, Jason S</creatorcontrib><creatorcontrib>Guo, Lifei</creatorcontrib><title>New Insight into an Old Paradigm: Wrapping and Dangling with Lower-Extremity Free Flaps</title><title>Journal of reconstructive microsurgery</title><addtitle>J reconstr Microsurg</addtitle><description>ABSTRACT
Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is examined as measured by ViOptix with wrapping and unwrapping during dangling at different postoperative time points. The results are compared with the nonaffected lower extremity and additional healthy controls. Upon dangling a reconstructed lower extremity, the tissue oximetry recording of a free flap descended rapidly until the leg was reelevated and then continued at this low level with a gradual return to the predangling baseline. The extent of this drop in tissue oxygenation depended upon positioning, and the length of time to reach its baseline upon reelevation decreased as flap matured postoperatively. In addition, wrapping of a reconstructed lower extremity also decreased the overall drop in tissue oxygenation level and the time to recovery while having no effect on the control. Results of this prospective study can lead to an increased understanding of free flap physiology in lower-extremity reconstruction and can further validate and refine our postoperative management strategies regarding dependency and edema control.</description><subject>Adult</subject><subject>Bandages</subject><subject>Biological and medical sciences</subject><subject>Edema - prevention & control</subject><subject>Exercise Therapy - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Free Tissue Flaps - blood supply</subject><subject>General aspects</subject><subject>Graft Rejection - prevention & control</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Leg Injuries - diagnosis</subject><subject>Leg Injuries - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microsurgery - methods</subject><subject>Movement</subject><subject>Oximetry</subject><subject>Oxygen Consumption - physiology</subject><subject>Postoperative Care - methods</subject><subject>Posture</subject><subject>Prospective Studies</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Reconstructive Surgical Procedures - rehabilitation</subject><subject>Regional Blood Flow</subject><subject>Risk Assessment</subject><subject>Treatment Outcome</subject><subject>Wound Healing - physiology</subject><subject>Young Adult</subject><issn>0743-684X</issn><issn>1098-8947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAQhi0EoqWwMiIviMngjzhO2FBpoVJFGSqVzXIcp3WVL-xEpf-eVA0wMZxOp3vuPekB4Jrge4I5f_AIY4YRoSGjMT0BQ4LjCEVxIE7BEIuAoTAKPgbgwvstxiSICT0HA4oFZnEUDcHqzezgrPR2vWmgLZsKqhIu8hS-K6dSuy4e4cqpurblutuk8FmV6_ww7GyzgfNqZxyafDXOFLbZw6kzBk5zVftLcJap3Jurvo_AcjpZjl_RfPEyGz_NkWYhbZAhGUljjkOdUB4yjoVIlcCCcs5ZkNCYJYQq0xUVWDNFE5qFIlaRNizjmo3A3TG2dtVna3wjC-u1yXNVmqr1UnBOQhJx0pH3R1K7yntnMlk7Wyi3lwTLg0rp5UGl7FV2Bzd9dJsUJv3Ff9x1wG0PKK9VnjlVauv_uC6FMRZ2HDpyzcaawsht1bqyc_Lf42-nnYf_</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Ridgway, Emily B</creator><creator>Kutz, Richard H</creator><creator>Cooper, Jason S</creator><creator>Guo, Lifei</creator><general>Thieme</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>New Insight into an Old Paradigm: Wrapping and Dangling with Lower-Extremity Free Flaps</title><author>Ridgway, Emily B ; Kutz, Richard H ; Cooper, Jason S ; Guo, Lifei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-e1f1d9506cb25635077da707255534b293b12ae12a270c3a2b2f679a8ce3f5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Bandages</topic><topic>Biological and medical sciences</topic><topic>Edema - prevention & control</topic><topic>Exercise Therapy - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Free Tissue Flaps - blood supply</topic><topic>General aspects</topic><topic>Graft Rejection - prevention & control</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Leg Injuries - diagnosis</topic><topic>Leg Injuries - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microsurgery - methods</topic><topic>Movement</topic><topic>Oximetry</topic><topic>Oxygen Consumption - physiology</topic><topic>Postoperative Care - methods</topic><topic>Posture</topic><topic>Prospective Studies</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Reconstructive Surgical Procedures - rehabilitation</topic><topic>Regional Blood Flow</topic><topic>Risk Assessment</topic><topic>Treatment Outcome</topic><topic>Wound Healing - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ridgway, Emily B</creatorcontrib><creatorcontrib>Kutz, Richard H</creatorcontrib><creatorcontrib>Cooper, Jason S</creatorcontrib><creatorcontrib>Guo, Lifei</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of reconstructive microsurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ridgway, Emily B</au><au>Kutz, Richard H</au><au>Cooper, Jason S</au><au>Guo, Lifei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>New Insight into an Old Paradigm: Wrapping and Dangling with Lower-Extremity Free Flaps</atitle><jtitle>Journal of reconstructive microsurgery</jtitle><addtitle>J reconstr Microsurg</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>26</volume><issue>8</issue><spage>559</spage><epage>566</epage><pages>559-566</pages><issn>0743-684X</issn><eissn>1098-8947</eissn><coden>JRMIE2</coden><abstract>ABSTRACT
Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is examined as measured by ViOptix with wrapping and unwrapping during dangling at different postoperative time points. The results are compared with the nonaffected lower extremity and additional healthy controls. Upon dangling a reconstructed lower extremity, the tissue oximetry recording of a free flap descended rapidly until the leg was reelevated and then continued at this low level with a gradual return to the predangling baseline. The extent of this drop in tissue oxygenation depended upon positioning, and the length of time to reach its baseline upon reelevation decreased as flap matured postoperatively. In addition, wrapping of a reconstructed lower extremity also decreased the overall drop in tissue oxygenation level and the time to recovery while having no effect on the control. Results of this prospective study can lead to an increased understanding of free flap physiology in lower-extremity reconstruction and can further validate and refine our postoperative management strategies regarding dependency and edema control.</abstract><cop>New York, NY</cop><pub>Thieme</pub><pmid>20703988</pmid><doi>10.1055/s-0030-1263292</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Bandages Biological and medical sciences Edema - prevention & control Exercise Therapy - methods Female Follow-Up Studies Free Tissue Flaps - blood supply General aspects Graft Rejection - prevention & control Graft Survival Humans Injury Severity Score Leg Injuries - diagnosis Leg Injuries - surgery Male Medical sciences Microsurgery - methods Movement Oximetry Oxygen Consumption - physiology Postoperative Care - methods Posture Prospective Studies Reconstructive Surgical Procedures - methods Reconstructive Surgical Procedures - rehabilitation Regional Blood Flow Risk Assessment Treatment Outcome Wound Healing - physiology Young Adult |
| title | New Insight into an Old Paradigm: Wrapping and Dangling with Lower-Extremity Free Flaps |
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