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Related Experiment Video

Updated: Mar 13, 2026

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Free flap rescue using an extracorporeal perfusion device.

Andreas M Fichter1, Lucas M Ritschl1, Andrea Rau1

  • 1Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, 81675, Germany.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|October 21, 2016
PubMed
Summary

Temporary extracorporeal perfusion of free flaps can prevent flap loss during emergencies. This method reduces warm ischemia time, ensuring flap survival without increasing complications.

Keywords:
Extracorporeal membrane oxygenationFree tissue flapsIschaemiaMicrocirculationWarm ischaemia

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Area of Science:

  • Plastic Surgery
  • Vascular Surgery
  • Regenerative Medicine

Background:

  • Microvascular free flaps are crucial in reconstructive surgery.
  • Prolonged warm ischemia time can lead to flap failure.
  • Emergency situations may necessitate extended ischemia periods.

Purpose of the Study:

  • To evaluate the efficacy of temporary extracorporeal perfusion for free flaps.
  • To assess the impact of this technique on flap survival and microcirculation.
  • To determine if extracorporeal perfusion can mitigate risks associated with prolonged ischemia.

Main Methods:

  • Eight radial forearm flaps underwent temporary extracorporeal perfusion (mean 147 minutes).
  • Flap perfusion was monitored using Indocyanine Green fluorescence angiography and laser Doppler.
  • Outcomes were compared to 30 patients receiving conventional radial forearm flap reconstruction.

Main Results:

  • Successful free flap transfer was achieved in all 8 cases after short-term perfusion (up to 4 hours).
  • No significant differences were observed in flap survival, microcirculation, complications, or hospital stay compared to the conventional group.
  • The technique effectively reduced warm ischemia time in critical situations.

Conclusions:

  • Temporary extracorporeal free flap perfusion is a viable strategy to prevent flap loss in emergency scenarios.
  • This method can safeguard critically perfused or congested flaps.
  • It offers a potential solution for managing unexpected delays in microvascular anastomosis.