Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report

During microanastomosis, the recipient artery must be controlled both proximally and distally, so that the donor flap artery may be anastomosed. Bulldog vascular clamps are often used; however, these clamps may fail to occlude heavily calcified vessels characteristic of diabetes and end-stage renal...

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Autores principales:	Kevin G. Kim, Chamilka S. Merle, Paige K. Dekker, Tanvee Singh, Cameron M. Akbari, Christopher E. Attinger, Karen K. Evans
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Free tissue transfer Vascular clamps Chronic lower extremity wound Surgery RD1-811
Acceso en línea:	https://doaj.org/article/0d422820167e4d4e88e2a67918f5e31b
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spelling	oai:doaj.org-article:0d422820167e4d4e88e2a67918f5e31b2021-12-02T05:02:03ZMicrosurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report2352-587810.1016/j.jpra.2021.07.007https://doaj.org/article/0d422820167e4d4e88e2a67918f5e31b2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352587821000681https://doaj.org/toc/2352-5878During microanastomosis, the recipient artery must be controlled both proximally and distally, so that the donor flap artery may be anastomosed. Bulldog vascular clamps are often used; however, these clamps may fail to occlude heavily calcified vessels characteristic of diabetes and end-stage renal disease. Alternative clamps may need to be utilized, with the attendant risk of vessel injury. Herein, we present a case of free flap necrosis secondary to vascular clamp-mediated periansastomotic stenosis of a calcified free flap recipient artery. In this case, a 74-year-old diabetic male underwent anterolateral thigh free flap reconstruction for a left medial foot wound. The recipient's dorsalis pedis artery was noted to be heavily calcified intraoperatively and Bulldog clamps were unable to gain proximal and distal control, requiring the use of small-angled DeBakey vascular clamps. Ischemic flap changes were noted on postoperative day four. Subsequent angiogram demonstrated severe stenosis at the perianastomotic sites of the dorsalis pedis where the DeBakey clamps were placed for control. The arterial lesions were treated with balloon angioplasty and the patient underwent multiple debridements and placement of a split-thickness skin graft over the wound. At the six-month follow up, the wound achieved complete healing with insetting of the skin graft. In certain cases, the use of DeBakey or Satinsky clamps for arterial control in microsurgery may predispose the artery to intimal injury, causing stenosis that should be recognized early so that arteriography may be performed expeditiously. In this study, alternative methods of vascular control are described.Kevin G. KimChamilka S. MerlePaige K. DekkerTanvee SinghCameron M. AkbariChristopher E. AttingerKaren K. EvansElsevierarticleFree tissue transferVascular clampsChronic lower extremity woundSurgeryRD1-811ENJPRAS Open, Vol 30, Iss , Pp 110-115 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Free tissue transfer Vascular clamps Chronic lower extremity wound Surgery RD1-811
spellingShingle	Free tissue transfer Vascular clamps Chronic lower extremity wound Surgery RD1-811 Kevin G. Kim Chamilka S. Merle Paige K. Dekker Tanvee Singh Cameron M. Akbari Christopher E. Attinger Karen K. Evans Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report
description	During microanastomosis, the recipient artery must be controlled both proximally and distally, so that the donor flap artery may be anastomosed. Bulldog vascular clamps are often used; however, these clamps may fail to occlude heavily calcified vessels characteristic of diabetes and end-stage renal disease. Alternative clamps may need to be utilized, with the attendant risk of vessel injury. Herein, we present a case of free flap necrosis secondary to vascular clamp-mediated periansastomotic stenosis of a calcified free flap recipient artery. In this case, a 74-year-old diabetic male underwent anterolateral thigh free flap reconstruction for a left medial foot wound. The recipient's dorsalis pedis artery was noted to be heavily calcified intraoperatively and Bulldog clamps were unable to gain proximal and distal control, requiring the use of small-angled DeBakey vascular clamps. Ischemic flap changes were noted on postoperative day four. Subsequent angiogram demonstrated severe stenosis at the perianastomotic sites of the dorsalis pedis where the DeBakey clamps were placed for control. The arterial lesions were treated with balloon angioplasty and the patient underwent multiple debridements and placement of a split-thickness skin graft over the wound. At the six-month follow up, the wound achieved complete healing with insetting of the skin graft. In certain cases, the use of DeBakey or Satinsky clamps for arterial control in microsurgery may predispose the artery to intimal injury, causing stenosis that should be recognized early so that arteriography may be performed expeditiously. In this study, alternative methods of vascular control are described.
format	article
author	Kevin G. Kim Chamilka S. Merle Paige K. Dekker Tanvee Singh Cameron M. Akbari Christopher E. Attinger Karen K. Evans
author_facet	Kevin G. Kim Chamilka S. Merle Paige K. Dekker Tanvee Singh Cameron M. Akbari Christopher E. Attinger Karen K. Evans
author_sort	Kevin G. Kim
title	Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report
title_short	Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report
title_full	Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report
title_fullStr	Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report
title_full_unstemmed	Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report
title_sort	microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: a case report
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/0d422820167e4d4e88e2a67918f5e31b
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Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report

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