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Palmar microcirculation does not deteriorate 2 years after radial artery harvesting—implications for reconstructive free forearm flap transfer

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Abstract

Background

The functional consequences after radial artery-based forearm flaps for hand microcirculation remain unclear. We hypothesized that palmar microcirculation is compromised after radial artery removal in arteriosclerotic patients.

Materials and methods

A total number of 114 patients were included undergoing elective coronary revascularization using the radial artery of the nondominant forearm with non-pathological Allen’s test. Palmar microcirculatory mapping with 1596 measurements was applied 2 years after removal of the radial artery regarding capillary flow, finger tip oxygenation, as well as postcapillary venous filling pressures throughout both hands using combined noninvasive real-time laser Doppler flowmetry and spectrophotometry.

Results

Only 2/56 positions revealed a difference beyond a 5% threshold 25 ± 5 months after radial artery removal. Superficial capillary blood flow decreased by 13% at the hypothenar eminence (242.0 ± 153.6 vs 275.6 ± 169.2, p = 0.009). Deep postcapillary venous filling pressure (8 mm) was significantly increased by 9% only at the fingertip of the fifth finger (112.4 ± 49.7 vs 103.0 ± 25.0, p = 0.033). No clinical signs of malperfusion were found after radial artery removal, and no patient was impaired in his daily palmar motor activity.

Conclusions

Pedicled removal of the radial artery does not compromise superficial or deep palmar capillary blood flow, finger tip oxygenation, or postcapillary venous filling pressures in a long-term perspective in arteriosclerotic patients. No clinical relevant signs of malperfusion or any deterioration of palmar motor function was encountered. The blood flow via the ulnar artery and the interosseal artery compensates palmar perfusion without microcirculatory deterioration even more than 2 years after removal of the radial artery.

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References

  1. Page R, Chang J (2006) Reconstruction of hand soft-tissue defects: alternatives to the radial forearm fasciocutaneous flap. J Hand Surg [Am] 31:847–856

    Article  Google Scholar 

  2. Pshenisnov KP, Minachenko VK, Sidorov VB (1989) Application of composite microsurgical tissue forearm flaps using radial artery. Acta Chir Plast 31:134–142

    PubMed  CAS  Google Scholar 

  3. Ge XZ, Juang GK (1996) Use of distal arteries for microvascular reconstruction in forearm and hand surgery. Microsurgery 17:180–183

    Article  PubMed  CAS  Google Scholar 

  4. Weinzweig N, Chen L, Chen ZW (1994) The distally based radial forearm fasciosubcutaneous flap with preservation of the radial artery: an anatomic and clinical approach. Plast Reconstr Surg 94:675–684

    Article  PubMed  CAS  Google Scholar 

  5. Girsch W, Knabl J, Rab M (2001) Revascularisation and defect coverage of the hand: special application of the radials forearm flap. Handchir Mikrochir Plast Chir 33:89–94

    Article  PubMed  CAS  Google Scholar 

  6. Lin Y, Cheng MH, Wei FC, Song D, Huang WC (2006) Proximal forearm flap based on a septocutaneous vessel from the radial artery. Plast Reconstr Surg 117:955–960

    Article  PubMed  CAS  Google Scholar 

  7. Bakhach J, Sentucq-Rigal J, Mouton P, Boileau R, Panconi B, Guimberteau JC (2006) The dorsoradial flap: a new flap for hand reconstruction. Anatomical study and clinical applications. Ann Chir Plast Esthet 51:42–60

    Google Scholar 

  8. Gardet H, Pinsolle V, Pelissier P, Casoli V, Martin D (2006) Antebrachial flap based on distal perforators of the radial artery: anatomic study of 10 cases. Ann Chir Plast Esthet 51:47–52

    Article  PubMed  CAS  Google Scholar 

  9. Hölzle F, Kesting MR, Nolte D, Loeffelbein DJ, Swaid S, Wolff KD (2006) Reversible ischemia after raising a radial forearm flap with ulceration of three fingers in a cigarette smoker. Br J Oral Maxillofac Surg 44:57–59

    Article  PubMed  Google Scholar 

  10. Carpentier A, Guermonprez JL, Del oche A, Frechette C, DuBost C (1973) The aorta-to-coronary radial artery bypass graft: a technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111–121

    Article  PubMed  CAS  Google Scholar 

  11. Desai ND, Cohen EA, Nayloer CD, Fremes SE, for the radial artery patency study investigators (2004) A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med 351:2302–2309

    Article  PubMed  CAS  Google Scholar 

  12. Possati G, Gaudino M, Prati F, Alessandrini F, Trani C, Glieca F, Mazzari MA, Luciani N, Schiavoni G (2003) Long-term results of the radial artery used for myocardial revascularization. Circulation 108(11):1350–1354

    Article  PubMed  Google Scholar 

  13. Frank KH, Kessler M, Appelaum K, Dümmler W (1989) The erlangen micro-lightguide spectrophotometer EMPHO I. Phys Med Biol 34:1883–1900

    Article  PubMed  CAS  Google Scholar 

  14. Knobloch K, Kraemer R, Lichtenberg A, Jagodzinski M, Gossling T, Richter M, Zeichen J, Hufner T, Krettek C (2006) Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 34:92–97

    Article  PubMed  Google Scholar 

  15. Ghazanfari M, Vogt L, Banzer W, Rhodius U (2002) Reproducibility of non-invasive blood flow measurements using laser Doppler spectroscopy. Phys Med Rehab Kuror 12:330–336

    Article  Google Scholar 

  16. Knobloch K, Lichtenberg A, Pichlmaier M, Mertsching H, Krug A, Klima U, Haverich A (2003) Microcirculation of the sternum following harvesting of the left internal mammary artery. Thorac Cardiovasc Surg 51:255–259

    Article  PubMed  CAS  Google Scholar 

  17. Knobloch K, Kraemer R, Lichtenberg M, Gossling T, Zeichen J, Krettek C (2005) Microcirculation of the ankle after cryo/cuff application in healthy volunteers. Int J Sports Med 27(3):250–255. DOI 10.1055/s-2005-865623

    Article  Google Scholar 

  18. Knobloch K, Kraemer R, Lichtenberg A, Jagodzinski M, Goessling T, Richter M, Zeichen J, Hufner T, Krettek C (2005) Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 34:92–97. DOI 10.1177/0363546505278705

    Article  PubMed  Google Scholar 

  19. Holze F, Loeffelbein DJ, Nolte D, Wolff KD (2006) Free flap monitoring using simultaneous non-invasive laser Doppler flowmetry and tissue spectrophotometry. J Craniomaxillofac Surg 34:25–33

    Google Scholar 

  20. Holze F, Rau A, Swaid S, Loeffelbein DJ, Nolte D, Wolff KD (2005) Simultaneous non-invasive monitoring for radial forearm and fibula flaps using laser Doppler flowmetry and spectrophotometry. Mund Kiefer Gesichtschir 9:290–299

    Article  Google Scholar 

  21. Chong WC, Ong PJ, Hayward CS, Collins P, Moat NE (2003) Effect of radial artery harvesting on forearm function and blood flow. Ann Thorac Surg 75(4):1171–1174

    Article  PubMed  Google Scholar 

  22. Rafael Sadaba J, Conroy JL, Burniston M, Maughan J, Munsch C (2001) Effect of radial artery harvesting on tissue perfusion and function of the hand. Cardiovasc Surg 9(4):378–382

    Article  PubMed  CAS  Google Scholar 

  23. Lee HS, Chang BC, Heo YJ (2004) Digital blood flow after radial artery harvest for coronary artery bypass grafting. Ann Thorac Surg 77:2071–2075

    Article  PubMed  Google Scholar 

  24. Stead SW, Stirt JA (1985) Assessment of digital blood flow and palmar collateral circulation. Allen’s test versus photoplethysmography. Int J Clin Monit Comput 2:29–34

    Article  PubMed  CAS  Google Scholar 

  25. Lee HS, Heo YJ, Chang BC (2005) Long-term digital blood flow after radial artery harvesting for coronary artery bypass grafting. Eur J Cardiothorac Surg 27:99–103

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Plastic, Hand and Reconstructive Surgery, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    K. Knobloch, S. Tomaszek, K. H. Busch & P. M. Vogt

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  1. K. Knobloch
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  2. S. Tomaszek
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  3. K. H. Busch
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  4. P. M. Vogt
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Correspondence to K. Knobloch.

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Best abstracts – Surgical Forum 2007.

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Knobloch, K., Tomaszek, S., Busch, K.H. et al. Palmar microcirculation does not deteriorate 2 years after radial artery harvesting—implications for reconstructive free forearm flap transfer. Langenbecks Arch Surg 392, 315–322 (2007). https://doi.org/10.1007/s00423-007-0178-1

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  • DOI: https://doi.org/10.1007/s00423-007-0178-1

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