After microsurgical technique was introduced in 1960 by Jacobson and Suarez, microvacular anastomosis of blood vessels with an external diameter of 0.8 to 1.0 mm soon became possible. Extensive tissue loss or destruction of recipient sites provided a serious and, at times, insurmountable challenge to the reconstructive surgeons. This became significantly apparent when tissue of varying histologic types was deficient and function seriously impaired. Reconstruction at times could no longer be accomplished by conventional method. Microsurgical composite tissue transfer is now available for reconstruction of these extensive defects.
We have done free flap transfer 6 times using micro vascular anastomosis since May, 1981. Among 6 flaps(in 5 patients), 2 were free groin flaps, 2 were free axillary flaps, and 2 were free dorsalis pedis flaps. Our results are summarized in table 1. This article also contains brief review of literature. We have drawn following results after experience of six free flap transfer using microvascular anastomosis.:
1) The exact anatomic evaluation of donor and recipient areas and skillful microvascular anastomosis technique will be required.
2) The vascular status and site of donor and recipient sites were evaluated with palpation and inspection. The angiography was done when such evaluations were inadequate.
3) The microvascular anastomosis was adequate with end-to-end anastomosis of one artery and one vein.
4) The donor site defect was repaired with primary closure except dorsalis pedis flap donor site.
5) The postoperative flap condition was checked with color, temperature, and capillary return
and the postoperative complication was relieved as soon as possible.
6) The postoperative anti-thrombogenic -medication was done with intravenous low molecular
weight dextran(daily 1.0 L) and oral aspirin(daily 500mgx2) without systemic heparinization
for average 1 week.
|