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CC BY 4.0 · Arch Plast Surg 2023; 50(03): 311-314
DOI: 10.1055/s-0043-1764309
Extremity/Lymphedema
Case Report

Mechanical Dilation of the Recipient Vessel with the DeBakey Vascular Dilator in Lower Extremity Reconstruction: A Report of Two Cases

Min-Gi Seo 
1   Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
,
Tae-Gon Kim 
1   Department of Plastic and Reconstructive Surgery, College of Medicine, Yeungnam University, Daegu, Korea
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Abstract

In lower extremity reconstruction, the recipient vessel often requires long-range mechanical dilation because of extensive vasospasm or plaque formation induced by concomitant atherosclerosis. While a forceps dilator can be used to manipulate and dilate vessels approximately 1 cm from their end, a DeBakey vascular dilator can dilate long-range vessels. The authors successfully performed free flap reconstruction of the lower extremity using the DeBakey vascular dilator. Of the two patients who underwent lower extremity reconstruction, one had extensive vasospasm, and the other had plaques in the recipient arteries. Irrigation with 4% lidocaine and dilation of the lumen with a forceps dilator were insufficient to restore the normal arterial blood flow. Instead, a DeBakey vascular dilator with a 1-mm diameter tip was gently inserted into the lumen. Then, to overcome vessel resistance, the dilator gently advanced approximately 10 cm to dilate the recipient artery. Normal arterial blood flow was gushed out after dilating the vessel lumen using a DeBakey vascular dilator. The vascular anastomosis was performed, and intravenous heparin 5000 IU was administered immediately after anastomosis. Prophylactic low-molecular-weight-heparin (Clexane, 1 mg/kg) was administered subcutaneously to both patients for 14 days. The reconstructed flap survived without necrosis in either patient.

Keywords

DeBakey vascular dilator - recipient vessel - lower extremity reconstruction - vasospasm - atherosclerosis

Authors' Contributions

All authors contributed to the case conception and design; T.-G. K provided the valuable case and performed the operation; data collection and analysis were performed by M.-G. S.; the first draft of the manuscript was written by M.-G. S.; all authors commented on previous versions of the manuscript; all authors read and approved the final manuscript.


Ethical Approval

This study was study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and approved by the Institutional Review Board of Yeungnam University Hospital (No. 2022-09-041: the registration number of the ethics board).


Patient Consent

The patients' consent was obtained for their clinical photographs for academic purposes.




Publication History

Received: 26 October 2022

Accepted: 13 January 2023

Article published online:
29 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Pu LLQ. Free flaps in lower extremity reconstruction. Clin Plast Surg 2021; 48 (02) 201-214
    CrossrefPubMedSearch in Google Scholar
  • 2 Jang YJ, Park MC, Hong YS. et al. Successful lower extremity salvage with free flap after endovascular angioplasty in peripheral arterial occlusive disease. J Plast Reconstr Aesthet Surg 2014; 67 (08) 1136-1143
    CrossrefPubMedSearch in Google Scholar
  • 3 Vargas CR, Iorio ML, Lee BT. A systematic review of topical vasodilators for the treatment of intraoperative vasospasm in reconstructive microsurgery. Plast Reconstr Surg 2015; 136 (02) 411-422
    CrossrefPubMedSearch in Google Scholar
  • 4 Fila B. The advantages of using vascular dilators in angioaccess surgery. Blood Purif 2020; 49 (06) 647-651
    CrossrefPubMedSearch in Google Scholar
  • 5 Loop FD, Effler DB, Spampinato N, Groves LK, Cheanvechai C. Myocardial revascularization by internal mammary artery grafts. A technique without optical assistance. J Thorac Cardiovasc Surg 1972; 63 (04) 674-680
    CrossrefPubMedSearch in Google Scholar
  • 6 Hahn HM, Cha B, Lee IJ. The retrograde limb of the internal mammary artery: an alternative inflow option for free flap breast reconstruction. Arch Hand Microsurg 2020; 25: 326-330
    CrossrefSearch in Google Scholar
  • 7 Turin SY, Walton RL, Dumanian GA, Hijjawi JB, LoGiudice JA, Alghoul M. Current practices in the management of postoperative arterial vasospasm in microsurgery. J Reconstr Microsurg 2018; 34 (04) 242-249
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Kapilan G, Arudchelvam J. Post-traumatic lower limb arterial spasm: a common entity and an important cause for diagnostic dilemma: a case series. Ann Short Reports. 2020; 3: 1057
    Search in Google Scholar
  • 9 Cavadas PC, Vera-Sempere FJ. Experimental free tissue transfer over perivascular-injured vessels: effect of in vivo freezing. Microsurgery 1996; 17 (06) 295-300
    CrossrefPubMedSearch in Google Scholar
  • 10 Bayat A. A novel irrigating vessel dilator for microsurgery. Plast Reconstr Surg 2001; 108 (03) 797-798
    CrossrefPubMedSearch in Google Scholar
  • 11 Pafitanis G, Kyprianou K, Chen HC. Microvascular anastomosis in atherosclerotic vessels: technical challenges and recommendations. J Plast Reconstr Aesthet Surg 2021; 74 (07) 1633-1701
    CrossrefPubMedSearch in Google Scholar
  • 12 Kaciulyte J, Losco L, Maruccia M. et al. Postsurgical antithrombotic therapy in microsurgery: our protocol and literature review. Eur Rev Med Pharmacol Sci 2019; 23 (10) 4448-4457
    PubMedSearch in Google Scholar
  • 13 Yousef MA, Dionigi P. Experimental thromboprophylaxis with low molecular weight heparin after microsurgical revascularization. J Hand Microsurg 2015; 7 (02) 256-260
    Thieme ConnectPubMedSearch in Google Scholar