J Reconstr Microsurg 2004; 20(1): 31-34
DOI: 10.1055/s-2004-818047
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA

Free Flap Neovascularization: Myth or Reality?

Krishna Kumar1 , Wayne Jaffe2 , N. J. M London3 , Sanjay Kumar Varma3
  • 1Christine M. Kleinert Institute, Louisville, KY
  • 2Stoke on Trent, North Staffordshire Medical School, UK
  • 3Leicester Royal Infirmary, Leicester, UK
Further Information

Publication History

accepted: July 28, 2003

Publication Date:
18 February 2004 (online)

The blood supply of 17 free flaps was studied several months after surgery. The aim was to see whether or not the free flaps acquired blood flow through vessels across the flap inset independently of the main vascular anastomoses. A color Doppler flowmeter was used to identify the original arterial and venous anastomoses, the vessels in the margin of the flap, and also across the flap inset. The main vascular pedicle was then manually compressed for 2 min and blood flow was again examined in the vessels at the margin of the flap. The flap vessels (post-anastomotic), the anastomoses, and the recipient vessels (pre-anastomotic) could be identified in every case. There was no evidence of anastomotic stenosis. No vessels (neo-vascularization) greater than 0.5 mm could be identified across the flap inset. Small arteries could be identified in the flap near the inset. These vessels emptied completely on manual compression of the vascular pedicle for 2 min and did not refill until the compression was released. This evidence suggests that the free flaps do not receive significant blood flow through vessels across the flap inset, and are therefore significantly dependent for vascularity on the original anastomoses even 1 year after surgery.

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K KumarM.B.B.S. M.S. F.R.C.S. M.Ch. F.R.C.S. (Plastic Surgery)  Plastic Surgeon

Baby Memorial Hospital

Indira Gandhi Road

Calicut, Kerala, South India 673004