Numerical simulations of different configured venous anastomosis in microvascular flap transfer.
Computational fluid dynamic
Free flap
Transit-time flow measurement
Venous anastomosis
Journal
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery
ISSN: 1878-4119
Titre abrégé: J Craniomaxillofac Surg
Pays: Scotland
ID NLM: 8704309
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
05
09
2018
revised:
26
01
2019
accepted:
04
02
2019
pubmed:
25
2
2019
medline:
18
12
2019
entrez:
25
2
2019
Statut:
ppublish
Résumé
Free flap surgery is a well-established method for covering large defects in the head and neck region. Most cases of flap failure are caused by venous thrombosis. Thus, there is a lot of discussion about the ideal design of venous anastomosis and its impact on the hemodynamics in the vessels. This study concentrates on the simulation of flow patterns of different designs of venous anastomoses. First, fluid flow rates were measured using transit-time flow measurement in the veins of 20 patients who received free flaps between 2016 and 2017. Five different designs of porcine anastomoses were scanned using micro-computed tomography, to create three-dimensional models. In the second step, numerical simulations of the blood flow were performed to gain insights into the vessel flow patterns. The simulations revealed recirculation areas in the 60° and 90° end-to-side anastomoses, especially in combination with low fluid flow rates. In addition, there were large areas of recirculation in the 1:3 end-to-end anastomoses. The type of venous anastomosis should be decided individually. End-to-side anastomosis can be recommended in cases with high caliber differences or in those with high venous outflow. End-to-end anastomoses should be preferred in conditions with low venous outflow.
Sections du résumé
BACKGROUND
BACKGROUND
Free flap surgery is a well-established method for covering large defects in the head and neck region. Most cases of flap failure are caused by venous thrombosis. Thus, there is a lot of discussion about the ideal design of venous anastomosis and its impact on the hemodynamics in the vessels. This study concentrates on the simulation of flow patterns of different designs of venous anastomoses.
METHODS
METHODS
First, fluid flow rates were measured using transit-time flow measurement in the veins of 20 patients who received free flaps between 2016 and 2017. Five different designs of porcine anastomoses were scanned using micro-computed tomography, to create three-dimensional models. In the second step, numerical simulations of the blood flow were performed to gain insights into the vessel flow patterns.
RESULTS
RESULTS
The simulations revealed recirculation areas in the 60° and 90° end-to-side anastomoses, especially in combination with low fluid flow rates. In addition, there were large areas of recirculation in the 1:3 end-to-end anastomoses.
CONCLUSION
CONCLUSIONS
The type of venous anastomosis should be decided individually. End-to-side anastomosis can be recommended in cases with high caliber differences or in those with high venous outflow. End-to-end anastomoses should be preferred in conditions with low venous outflow.
Identifiants
pubmed: 30797662
pii: S1010-5182(18)30662-0
doi: 10.1016/j.jcms.2019.02.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
792-797Informations de copyright
Copyright © 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.