OBJECTIVE: The incidence of critical limb ischemia increases with the ageing of the population. Two thirds of the patients present trophic disorders. Revascularization decreases the rate of amputation. The wounds infected with exposure of the tendons, bones or articulations cannot heal in spite of a bridging and local debridement. Surgery associating a distal venous bypass or recanalisation and a free flap makes it possible to treat the losses of substances and presents a hemodynamic advantage, by increasing the flow of the bypass, thanks to the vascular bed added by the flap. It is a complex surgery because of the multiplicity of anastomoses on the same arterial axis, with a risk of thromboses and complications related to the venous autograft. To mitigate these disadvantages, we proposed a new surgical method based on the use of a single anatomical unit, the epiploic bypass flap (BF), based on the gastroepiploic artery (GEA) as the inflow for a bypass and a free flap. The objective of this work was to analyze the anatomical feasibility of an epiploic bypass flap and to determine its limits. MATERIAL AND METHODS: 100 anatomical preparations were carried out with a measure of the internal and external diameters and the lengths of GEA and its branches as well as an X-ray after injection of a radiopaque product. A first clinical application was carried out. RESULTS: According to the data analysis our study confirms the anatomical feasibility of a bypass flap. The average available length of GEA is 245 mm (210-280 mm). The average proximal diameter is 3 mm and the distal one is 1.5 mm. The most distal epiploic branch which feeds the bypass is approximately 180 mm (161-195 mm) of the origin of the gastroepiploic artery. The anatomical unit based on the GEA provides an arterial graft relatively long and a large flap, malleable and resistant to infection. CONCLUSIONS: Epiploic bypass flap is a surgical technique which allows distal revascularization and a simultaneous cover of the limb extremity. This technique can be useful in patients requiring a distal revascularization associated with a cutaneous cover.

Epiploic bypass flap: a new method of limb salvage. Anatomical bases and clinical application.

BUSSANI, ROSSANA;
2013-01-01

Abstract

OBJECTIVE: The incidence of critical limb ischemia increases with the ageing of the population. Two thirds of the patients present trophic disorders. Revascularization decreases the rate of amputation. The wounds infected with exposure of the tendons, bones or articulations cannot heal in spite of a bridging and local debridement. Surgery associating a distal venous bypass or recanalisation and a free flap makes it possible to treat the losses of substances and presents a hemodynamic advantage, by increasing the flow of the bypass, thanks to the vascular bed added by the flap. It is a complex surgery because of the multiplicity of anastomoses on the same arterial axis, with a risk of thromboses and complications related to the venous autograft. To mitigate these disadvantages, we proposed a new surgical method based on the use of a single anatomical unit, the epiploic bypass flap (BF), based on the gastroepiploic artery (GEA) as the inflow for a bypass and a free flap. The objective of this work was to analyze the anatomical feasibility of an epiploic bypass flap and to determine its limits. MATERIAL AND METHODS: 100 anatomical preparations were carried out with a measure of the internal and external diameters and the lengths of GEA and its branches as well as an X-ray after injection of a radiopaque product. A first clinical application was carried out. RESULTS: According to the data analysis our study confirms the anatomical feasibility of a bypass flap. The average available length of GEA is 245 mm (210-280 mm). The average proximal diameter is 3 mm and the distal one is 1.5 mm. The most distal epiploic branch which feeds the bypass is approximately 180 mm (161-195 mm) of the origin of the gastroepiploic artery. The anatomical unit based on the GEA provides an arterial graft relatively long and a large flap, malleable and resistant to infection. CONCLUSIONS: Epiploic bypass flap is a surgical technique which allows distal revascularization and a simultaneous cover of the limb extremity. This technique can be useful in patients requiring a distal revascularization associated with a cutaneous cover.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2760770
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