The Experts below are selected from a list of 216 Experts worldwide ranked by ideXlab platform
Ramon M. Esclamado - One of the best experts on this subject based on the ideXlab platform.
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ischemia reperfusion injury in Microvascular Surgery
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2000Co-Authors: William R. Carroll, Ramon M. EsclamadoAbstract:Ischemia/reperfusion injury is often the final and irreversible factor causing flap failure in Microvascular Surgery for head and neck defects. This paper begins with a detailed review of flap physiology and ischemia/reperfusion injury at the cellular level. Subsequently, the pharmacotherapeutic agents used clinically and experimentally to avoid or reverse ischemia/reperfusion injury are discussed. The goal of this review is to provide a framework for understanding the expanding body of literature relevant to ischemia/reperfusion injury in Microvascular Surgery.
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Ischemia/reperfusion injury in Microvascular Surgery.
Head & neck, 2000Co-Authors: William R. Carroll, Ramon M. EsclamadoAbstract:Ischemia/reperfusion injury is often the final and irreversible factor causing flap failure in Microvascular Surgery for head and neck defects. This paper begins with a detailed review of flap physiology and ischemia/reperfusion injury at the cellular level. Subsequently, the pharmacotherapeutic agents used clinically and experimentally to avoid or reverse ischemia/reperfusion injury are discussed. The goal of this review is to provide a framework for understanding the expanding body of literature relevant to ischemia/reperfusion injury in Microvascular Surgery.
John H. Barker - One of the best experts on this subject based on the ideXlab platform.
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A Review of Thrombosis and Antithrombotic Therapy in Microvascular Surgery
European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes, 2013Co-Authors: Dara Froemel, S.-j. Fitzsimons, J. Frank, M. Sauerbier, Andrea Meurer, John H. BarkerAbstract:Despite a remarkable expansion of microSurgery, there is still no international consensus about routinely used prophylactic antithrombotic agents. Most treatment regimens still use aspirin, heparin (low-molecular-weight and unfractionated heparin) or colloids (hydroxyphenylacetate 6%/dextran); however, clear evidence for the clinical benefit of an ideal administration regimen or one agent over the other has not yet been established. Instead of searching for the one regime that fits all, an increasing number of reviews from different disciplines describe multistep approaches that optimize what has been shown to be most promising. This includes the use of antithrombotic agents, proper risk assessment, secondary prevention and professional training to optimize microsurgical skills. In this review, we describe factors included in traditional approaches and also emphasize the value of good surgical technique, which while recognized by all to be one of the most important factors for success, receives less emphasis in reviews describing thrombosis prophylaxis in Microvascular Surgery.
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Microcirculatory consequences of Microvascular Surgery.
Microsurgery, 1994Co-Authors: M. O’shaughnessy, Frances Wyllie, Robert D. Acland, Gary L. Anderson, Joseph C. Banis, John H. BarkerAbstract:Although free tissue transfer success has been greatly improved by developments in operating microscopes, microsutures, microinstruments, and technique, free flap and replant failure remain a significant problem under certain adverse circumstances. The nature of these failures is often multifactorial and remains poorly understood. A greater understanding of the processes involved would provide the potential for greater pharmacological control of any adverse conditions prevailing and would thus offer the prospect of more effective adjunctive therapy in the presence of such adverse conditions. Research endeavors in this area have been hindered by the absence of good research models. The isolated rat cremaster muscle model is a recently developed model that simulates the conditions of free tissue transfer. Using this model, both thrombus formation and numerous microcirculatory parameters can be measured. The microcirculatory parameters studied to date include the formation of thromboembolism, capillary perfusion, vessel diameters, red blood cell velocity, leukocyte-endothelium interaction, and Microvascular leakage. The isolated rat cremaster muscle model addresses many of the shortcomings of earlier research models and offers the promise of answering at least some of the many unanswered questions relating to free flap and replant failure.
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Thrombosis and Antithrombotic Therapy in Microvascular Surgery
Clinics in plastic surgery, 1992Co-Authors: Peter C. Johnson, John H. BarkerAbstract:Thrombosis in microSurgery can either totally or partially reduce the perfusion to the free tissue transfer. Total occlusion normally occurs at or near the Microvascular anastomosis, while microscopic vasospasm in the distal microcirculation can account for malperfusion and wound healing problems. The mechanisms of the anastomotic and microcirculatory responses to thrombosis are discussed. Drug therapy for each risk zone is identified, and a rationale for therapy is given.
Keith E Blackwell - One of the best experts on this subject based on the ideXlab platform.
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vasodilation by verapamil nitroglycerin solution in Microvascular Surgery
Otolaryngology-Head and Neck Surgery, 2021Co-Authors: Rahul Seth, Karam W Badran, Elizabeth Cedars, Karolina Plonowska, Tania Benjamin, Satvir Saggi, Daniel P Knott, Chase M Heaton, Keith E BlackwellAbstract:ObjectivePapaverine is a topical vasodilator commonly used during Microvascular Surgery to inhibit undesired vasoconstriction. A previous national shortage of papaverine prompted evaluation of an a...
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Vasodilation by Verapamil-Nitroglycerin Solution in Microvascular Surgery.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2020Co-Authors: Rahul Seth, Karam W Badran, Elizabeth Cedars, Karolina Plonowska, Tania Benjamin, Satvir Saggi, Chase M Heaton, P. Daniel Knott, Keith E BlackwellAbstract:Papaverine is a topical vasodilator commonly used during Microvascular Surgery to inhibit undesired vasoconstriction. A previous national shortage of papaverine prompted evaluation of an alternative, effective vasodilator. This study aims to assess the experience of a solution of verapamil and nitroglycerin (VG) as a potential alternative pharmacologic vasodilator. Retrospective case series. Two tertiary academic medical centers. Among 298 patients, 306 consecutive free tissue transfers performed between 2014 and 2017 for head and neck defect reconstruction utilized a VG solution. Patient and flap characteristics, intraoperative patient and flap complications, and postoperative complications were reviewed. Diameter of the cervical recipient artery was measured intraoperatively before and after topical application of the VG solution in a subset of 43 patients (44 flaps). Flaps included fibula, radial forearm, subscapular system, and anterolateral thigh. In total, 3 (0.98%) flaps failed with varied etiology unrelated to the VG solution (venous thrombosis, arterial anastomosis thrombosis, physical damage to the perforator). Specific to topical application of the VG solution, the mean recipient artery diameter increased from 2.1 to 3.1 mm, a 48% increase (P < .01). There were no intraoperative cardiac events or complications attributable to the VG solution. We describe the use of a VG solution for pharmacologic vasodilation during Microvascular free tissue transfer. Its use was associated with an acceptable incidence of adverse events, none of which were directly attributable to the VG solution. Apparent and sustained vasodilation was demonstrated. The VG solution represents a safe and efficacious alternative to papaverine in Microvascular Surgery.
William R. Carroll - One of the best experts on this subject based on the ideXlab platform.
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ischemia reperfusion injury in Microvascular Surgery
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2000Co-Authors: William R. Carroll, Ramon M. EsclamadoAbstract:Ischemia/reperfusion injury is often the final and irreversible factor causing flap failure in Microvascular Surgery for head and neck defects. This paper begins with a detailed review of flap physiology and ischemia/reperfusion injury at the cellular level. Subsequently, the pharmacotherapeutic agents used clinically and experimentally to avoid or reverse ischemia/reperfusion injury are discussed. The goal of this review is to provide a framework for understanding the expanding body of literature relevant to ischemia/reperfusion injury in Microvascular Surgery.
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Ischemia/reperfusion injury in Microvascular Surgery.
Head & neck, 2000Co-Authors: William R. Carroll, Ramon M. EsclamadoAbstract:Ischemia/reperfusion injury is often the final and irreversible factor causing flap failure in Microvascular Surgery for head and neck defects. This paper begins with a detailed review of flap physiology and ischemia/reperfusion injury at the cellular level. Subsequently, the pharmacotherapeutic agents used clinically and experimentally to avoid or reverse ischemia/reperfusion injury are discussed. The goal of this review is to provide a framework for understanding the expanding body of literature relevant to ischemia/reperfusion injury in Microvascular Surgery.
Karam W Badran - One of the best experts on this subject based on the ideXlab platform.
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vasodilation by verapamil nitroglycerin solution in Microvascular Surgery
Otolaryngology-Head and Neck Surgery, 2021Co-Authors: Rahul Seth, Karam W Badran, Elizabeth Cedars, Karolina Plonowska, Tania Benjamin, Satvir Saggi, Daniel P Knott, Chase M Heaton, Keith E BlackwellAbstract:ObjectivePapaverine is a topical vasodilator commonly used during Microvascular Surgery to inhibit undesired vasoconstriction. A previous national shortage of papaverine prompted evaluation of an a...
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Vasodilation by Verapamil-Nitroglycerin Solution in Microvascular Surgery.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2020Co-Authors: Rahul Seth, Karam W Badran, Elizabeth Cedars, Karolina Plonowska, Tania Benjamin, Satvir Saggi, Chase M Heaton, P. Daniel Knott, Keith E BlackwellAbstract:Papaverine is a topical vasodilator commonly used during Microvascular Surgery to inhibit undesired vasoconstriction. A previous national shortage of papaverine prompted evaluation of an alternative, effective vasodilator. This study aims to assess the experience of a solution of verapamil and nitroglycerin (VG) as a potential alternative pharmacologic vasodilator. Retrospective case series. Two tertiary academic medical centers. Among 298 patients, 306 consecutive free tissue transfers performed between 2014 and 2017 for head and neck defect reconstruction utilized a VG solution. Patient and flap characteristics, intraoperative patient and flap complications, and postoperative complications were reviewed. Diameter of the cervical recipient artery was measured intraoperatively before and after topical application of the VG solution in a subset of 43 patients (44 flaps). Flaps included fibula, radial forearm, subscapular system, and anterolateral thigh. In total, 3 (0.98%) flaps failed with varied etiology unrelated to the VG solution (venous thrombosis, arterial anastomosis thrombosis, physical damage to the perforator). Specific to topical application of the VG solution, the mean recipient artery diameter increased from 2.1 to 3.1 mm, a 48% increase (P < .01). There were no intraoperative cardiac events or complications attributable to the VG solution. We describe the use of a VG solution for pharmacologic vasodilation during Microvascular free tissue transfer. Its use was associated with an acceptable incidence of adverse events, none of which were directly attributable to the VG solution. Apparent and sustained vasodilation was demonstrated. The VG solution represents a safe and efficacious alternative to papaverine in Microvascular Surgery.