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논문 기본 정보

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학술저널
저자정보
GyeongHyeon Doh (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea) 김범식 (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea) DongYun Lee (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea) 윤정수 (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea) SooA Lim (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea) 한예식 (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea) SuRak Eo (Department of Plastic and Reconstructive Surgery Dongguk University School of Medicine Seoul Korea)
저널정보
대한수부외과학회 Archives of Hand and Microsurgery Archives of Hand and Microsurgery Vol.26 No.4
발행연도
2021.12
수록면
285 - 292 (8page)
DOI
10.12790/ahm.21.0118

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Purpose: Various factors such as blood velocity, turbulent flow,and intimal injury are the most basic elements in free tissue transfers. However, how blood flow is reestablished, maintained, and changed after vascular anastomosis has rarely been studied. Methods: A 54-year-old male sustained an unreplantable severe crushing injury to his right hand. The middle finger was transferred to the thumb as an ectopic replantation using an anastomosis between the radial and digital arteries. However, secondary reconstruction for the first web space defect was inevitable and an anteromedial thigh free flap procedure was performed 2 months later using the previously anastomosed vessels. During the procedures, we noted morphologic changes in the microvessels and tried to explain those phenomena by applying the principles of hemodynamics. Results: Due to the discrepancy in vascular size between the radial and digital arteries, the velocity of the blood flow in the post-anastomotic site, which was the digital artery, must have been increased by Poiseuille’s law. Supposing that the velocity through the post-anastomotic site of the digital artery was increased, the pressure exerted by that flow decreased, resulting in more shrinkage of the vessel lumen of the digital artery by Bernoulli’s principle. Pascal’s law could also be applied in confined spaces with a static flow; where there is a constant pressure, as the radius of the post-anastomotic digital artery diminishes, the tension within the digital artery’s wall also simultaneously decreases. By Laplace’s law, the post-anastomotic digital artery’s wall thickens as less tension is exerted on the wall. Conclusion: Understanding these simple flow mechanics will enable microsurgeons to better avoid the risk factors causing thrombosis, which is related to flap failure.
#Hemodynamics #Free tissue flaps #Surgical anastomosis #Blood flow velocity #Blood flow pressure

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참고문헌 (39)

참고문헌 신청
Bui DT / 2007 / Free flap reexploration : indications, treatment, and outcomes in 1193 free flaps / Plast Reconstr Surg 119:2092~2100 google schola Sigurdsson GH / 1995 / Perioperative fluid management in microvascular surgery / J Reconstr Microsurg 11:57~65 google schola Booi DI / 2011 / Perioperative fluid overload increases anastomosis thrombosis in the free TRAM flap used for breast reconstruction / Eur J Plast Surg 34:81~86 google schola Lorenzetti F / 1999 / Postoperative changes in blood flow in free muscle flaps : a prospective study / Microsurgery 19:196~199 google schola Ichinose A / 2004 / Reestablished circulation after free radial forearm flap transfer / J Reconstr Microsurg 20:207~213 google schola

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