Related Experiment Video
Updated: Mar 27, 2026
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An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
390
Free flap transplantation using an extracorporeal perfusion device: First three cases
Klaus-Dietrich Wolff1, Thomas Mücke1, Achim von Bomhard1
1Department of Oral and Cranio-Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany.
Summary
This study demonstrates successful mandibular reconstruction using free flaps without vessel connection in patients with depleted neck vessels. Temporary extracorporeal perfusion allowed flaps to develop their own blood supply, offering new surgical options.
Area of Science:
- Surgical Innovation
- Vascular Surgery
- Reconstructive Surgery
Background:
- Free flap transplantation is limited in patients with compromised recipient vessels.
- Mandibular composite reconstructions typically require anastomosis to recipient vessels.
- Vessel-depleted necks pose a significant challenge for free flap viability.
Purpose of the Study:
- To evaluate the feasibility of mandibular composite reconstructions using free flaps without anastomosis.
- To assess the efficacy of temporary extracorporeal perfusion for flap survival in vessel-depleted necks.
- To present a novel technique for complex reconstructive challenges.
Main Methods:
- Utilized temporary extracorporeal perfusion of free flaps for 10-13 days.
- Connected flap artery to a blood transfusion bag with arterialized blood under rhythmic compression.
- Monitored flap viability using laser Doppler flowmetry and remission spectroscopy.
- Collected venous blood without reinfusion, necessitating systemic blood transfusions.
Main Results:
- Achieved successful bony reconstructions in all three patients.
- Demonstrated neovascularization in soft tissues of all flaps, with one skin paddle experiencing necrosis.
- Required significant systemic transfusion of packed red cells (12-25 units) to manage blood loss.
Conclusions:
- This technique enables free flap transplantation in the absence of recipient vessels, expanding treatment options for complex cases.
- Further research into blood reinfusion is recommended to mitigate excessive transfusion requirements.
- The study offers a viable alternative for patients previously ineligible for free flap surgery.
