Skin flap necrosis is a serious problem in reconstructive head and neck surgery. Currently, the only clinically effective means of preventing flap necrosis is delay. Hypothesized mechanisms of delayed and experimental methods of increasing flap survival are discussed. Investigative data supporting the use of phentolamine to augment flap survival are presented.
Get full access to this article
View all access options for this article.
References
1.
ToomeyJMO'neillJVSnyderGGIII: Bridge method of skin-flap delay. Arch Otolaryngol103:26–28, 1977.
2.
GnudiMTWebsterJP: Gaspare Tagliacozzi. Los Angeles, Zeittin & Ver Brugge, 1976, p 208.
3.
BrownJBMcDowellF: Skin Grafting. Philadelphia, JB Lippincott Co, 1959, p 102.
4.
McFarlaneRMHeagyFCRadinS: A study of the delay phenomenon in experimental pedicle flaps. Plast Reconstr Surg35:245–262, 1965.
5.
MiltonSH: Experimental studies on island flaps. II. Ischemia and delay. Plast Reconstr Surg49:444–447, 1972.
6.
MyersMBCherryG: Mechanism of the delay phenomenon. Plast Reconstr Surg39:397–401, 1967.
7.
ToomeyJMWilsonWR: Mass spectrometric observations of skin flap physiology. laryngoscope83:559–567, 1973.
8.
GuthrieRHJr.GoulianDCucinRL: Predicting the extent of viability in flaps by measure of gas tensions, using a mass spectrometer. Plast Reconstr Surg50:385–389, 1972.
9.
GrabbWCMyersMB: Skin Flaps. Boston, Little Brown & Co, 1975, p 72.
10.
ThompsonFMBerkhaGGGuthrieRHJr.: The effective duration of the delay phenomenon in the rat. Plast Reconstr Surg60:384–389, 1977.
11.
GilliesHD: The tubed pedicle in plastic surgery. NY State J Med3:1–3, 1920.
12.
GilliesHD: Practical uses of the tubed pedicle flap. Am J Surg43:201–215, 1939.
13.
GermanWFinesilverEMDavisJS: Establishment of circulation in tubed skin flaps. Arch Surg26:27–40, 1933.
14.
HynesW: The blood vessels in skin tubes and flaps. Br J Plast Surg3:165–175, 1950.
15.
BraithwaiteF: Some observations on the vascular channels in tubed pedicles. II. Br J Plast Surg4:28–37, 1951.
16.
DeHaanCRStarkRB: Changes in efferent circulation of tubed pedicles and in the transplantability of large composite grafts produced by histamine iontophoresis. Plast Reconstr Surg28:577–583, 1961.
17.
VelanderE: Vascular changes in tubed pedicles: An animal experimentation study. Acta Chir Scand (suppl):322, 1964.
18.
ReinischJ: The pathophysiology of skin flap circulation. The delay phenomenon. Plast Reconstr Surg54:585–598, 1974.
19.
CuttingCBRobsonMCKossN: Denervation supersensitivity and the delay phenomenon. Plast Reconstr Surg61:881–887, 1978.
20.
KiehnCLDesprezJD: Effects of local hypothermia on pedicle flap tissue. I. Enhancement of survival of experimental pedicles. Plast Reconstr Surg25:349–359, 1960.
21.
JurellGKaijserL: The influence of varying pressure and duration of treatment with hyperbaric oxygen on the survival of skin flaps. Scan J Plast Reconstr Surg7:25–28, 1973.
22.
KernahanDAZwiggWKayCW: The effect of hyperbaric oxygen on the survival of experimental skin flaps. Plast Reconstr Surg36:19–25, 1965.
23.
RubergRLFalconeRE: Effect of protein depletion on the surviving length in experimental skin flaps. Plast Reconstr Surg61:581–587, 1978.
24.
MyersMBCherryG: Augmentation of survival in pedicle skin flaps by the chemical production of ischemia. Surg Forum22:485–486, 1971.
25.
BarisoniDMVeallN: Effect of thymoxamine on circulation in skin flaps and in denervated skin, Lancet1:400–401, 1969.
26.
NorbergKPalmerB: Improvement of blood circulation in experimental skin flaps by phentolamines. Eur J Pharmacol8:36–38, 1969.
27.
PalmerB: The influence of stress on the survival of experimental skin flaps. Scand J Plast Reconstr Surg6:110–113, 1972.
28.
MyersMBCherryG: Enhancement of survival in devascularized pedicles by the use of phenoxybenzamine. Plast Reconstr Surg41:254–260, 1968.
29.
FinsethFAdelbergMG: Prevention of skin flap necrosis by a course of treatment with vasodilator drugs. Plast Reconstr Surg61:738–743, 1978.
30.
PalmerB: Sympathetic denervation and reinnervation of cutaneous blood vessels following surgery. Scand J Plast Reconstr Surg4:93–99, 1970.
31.
MyersMBCherryGMiltonS: Tissue gas levels as an index of the adequacy of circulation: The relation between ischemia and the development of collateral circulation (delay phenomenon). Surgery71:15–21, 1972.
