Donor Vessels Research Articles

Clinical and angiographic predictors of success in chronic total occlusion coronary angioplasty

Objective The aim of this study was to define the preinterventional parameters for procedural success of chronic total occlusion (CTO) coronary angioplasty. Background CTOs are encountered in 15–30% of patients undergoing coronary angiography. Compared with failed CTO angioplasty, successful CTO angioplasty has been associated with improvement in angina and left ventricular function and increased survival. Compared with intervention of nonoccluded stenoses, the recanalization of CTOs requires expert operator skills, increased procedural time, and increased radiation exposure to the patient, physician, and catheterization laboratory staff. Materials and methods This prospective study was conducted from April 2014 to March 2015 in Kobry El Kobba Military Hospital and included 30 patients with CTO of more than 1-month duration having significant angina (class III/IV) or recent acceleration of previously chronic stable angina. Clinical and angiographic variants were listed, and rate of success and failure of each was calculated after CTO angioplasty trial. Results There were 25 successful angioplasty cases. There was no significant affection of the different clinical variants and risk factors on the success rate. On the contrary, some of the angiographic variants showed a significant affection on the success and failure rates. The criteria of failure were difficult antegrade and retrograde wiring, unhealthy donor vessel, blunt calcified distal cap, and no continuous collaterals. Conclusion The success rate of CTO percutaneous coronary intervention mainly depends on certain angiographic factors. The clinical factors, although not statistically significant, play a crucial role in decision planning of CTO percutaneous coronary intervention.

TachoSil Dural Reconstruction in Extracranial-Intracranial Bypass Surgeries.

Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a treatment option for hemodynamic insufficiency in the anterior cerebral circulation. Complications associated with extracranial-intracranial bypass surgeries are ischemic strokes caused by bypass failure, wound-healing disorders, and further issues from cerebrospinal fluid (CSF) leakage. CSF leakage can provide pathways for infection. It is well known in general neurosurgery that watertight closure of the dura mater is necessary to prevent such complications. To provide a technical description of TachoSil dural reconstruction in standard STA-MCA bypasses and their follow-up analyses. In this technical report with observational follow-up, the dura mater was closed partially by adaptive sutures, and the perforation site of the donor vessel was sealed with TachoSil. TachoSil is a collagen sponge covered with clotting factors that provides hemostatic and sealing effects. Our study included eight cases of standard STA-MCA bypasses that had been operated between July 2015 and September 2016. Follow-up examinations were completed for all patients at 1 month and 6 months after surgery. Duplex and Doppler ultrasound demonstrated regular bypass patency in all patients without increased flow velocity at the perforation sites, which is a possible sign of stenosis. No wound-healing disorders or CSF leakage occurred. No cerebrovascular stroke events were observed. Duraplasty with TachoSil enables the elastic reconstruction of the dura perforation gap in standard extracranial-intracranial bypass surgeries.

Efficacy of STA-MCA bypass surgery in moyamoya angiopathy: long-term follow-up of the Caucasian Krupp Hospital cohort with 81 procedures.

Despite the consensus on the efficacy of revascularizing surgery in moyamoya angiopathy (MA) in Asia, the indication in Caucasian moyamoya patients is controversially discussed. The efficacy of revascularizing surgery in adult European patients with MA should be clarified. This study retrospectively analyzed the rate of further strokes and hemorrhages as well as MRI and Duplex ultrasound features during long-term follow up after STA-MCA bypass. Eighty-one STA-MCA bypass procedures in 54 patients with MA operated in one single German institution were analyzed. All 54 patients (100%) were Caucasians. After two diffusion restricted spots in MRI perioperatively (2.5%) and short-lasting symptoms directly after surgery, no patient experienced further new symptoms related to stroke or hemorrhages nor no new gliotic scars or microbleeds on MRI for 38.2months. Duplex ultrasound 3months after surgery documented bypass patency in 100% and sonographic sign for good relevance of the bypass in 96.2%. In addition, the diameter of the donor vessel had increased in 89.9% as an indicator for the relevance of the bypass. Semi-quantitative analysis of perfusion changes in the operated hemispheres demonstrated an increase in perfusion in the MCA territory in 56 of 74 (75.7%) hemispheres 36.7months after surgery. In MRA images, a reduction of typical moyamoya collaterals was found in 65 of 79 hemispheres (82.3%) after a mean of 37.2months. Direct STA-MCA bypass is an effective therapy in Caucasian patients with hemodynamically compromised MA.

Complete portal vein occlusion after cyanoacrylate sclerotherapy in biliary atresia treated by living donor liver transplantation with intraoperative portal vein stenting via segment 4 portal vein stump.

Living donor liver transplantation (LDLT) is a durable treatment for end-stage liver disease due to biliary atresia (BA) with excellent graft and patient survivals as shown in our previous study (1). Vascular complications are a major cause of graft failure in LDLT, particularly in children, where size disparity between donor and recipient vessels is often unavoidable.

The Value of the Middle Meningeal Artery in Cerebrovascular Bypass Surgery: An Anatomic Feasibility Study.

Over the past decade, there has been a revival and a renewed interest for cerebrovascular bypass procedures. The superficial temporal artery (STA) has its value as a reliable donor vessel; however, a possible role for the middle meningeal artery (MMA) as a donor artery is still unclear. To assess the feasibility of using the MMA as a donor vessel in cerebrovascular surgery. We performed cadaveric dissections on 12 fresh specimens (23 sides) after bilateral silicone injection into the internal and external carotid arteries. We compared the size, diameter, and possibility to perform a bypass to the middle cerebral artery for both the MMA and the STA. Measurements were done using an electrical caliper. Additional measurements of the MMA and STA were performed on 20 random angiograms. There was no statistically significant difference in diameter of the MMA at its ostium being 2.4 mm, compared to 2.7 mm for the STA ostium (t-test; P = .21). The MMA could be mobilized over 4.1 cm, whereas the STA over 8.3 cm. Finally, the mean diameter of the donor vessel at the site of the anastomosis was 1.6 mm versus 1.9 mm for MMA and STA, respectively (P = .0026). We were able to perform an MMA and middle cerebral artery anastomosis on 17 sides. These results suggest that the MMA is a potentially valuable donor vessel to be used in selected cases. The availability of a suitable MMA branch should be assessed preoperatively on the angiogram.

Use of a microvascular coupler device for end-to-side venous anastomosis in oral and maxillofacial reconstruction

The aim of this study was to compare the use of a microvascular coupler device (MCD) for end-to-side venous anastomosis (ETS group) and phleboplasties combined with MCD for end-to-end venous anastomosis (ETE group) in free tissue transfer for oral and maxillofacial reconstruction, with regard to the anastomosis time and occurrence of postoperative vascular crisis. The ETS group included 22 patients and the ETE group included 40 patients. Patient demographic data, anastomotic time, coupler size, microvascular complications, and flap survival rates were collected and analyzed. In the ETS group, the most suitable donor vessel size was greater than 2mm, varying from 2mm to 4mm. The average anastomosis time was 3.35±0.89min in the ETS group and 7.80±2.93min in the ETE group; the difference between the groups was statistically significant (p<0.0001). There were no statistically significant differences in complications or outcomes between the two groups. The ETS venous anastomosis with MCD technique is a better choice for anastomosis when the donor vessel size is greater than 2mm. In those cases with mismatched veins, ETS venous anastomosis with MCD could significantly reduce the anastomosis time compared to ETE venous anastomosis with MCD after phleboplasties.

In Reply to “Feasibility of Using Internal Thoracic Artery as Donor Vessel in High-Flow Intracranial Bypass Surgery”

In Reply to “Feasibility of Using Internal Thoracic Artery as Donor Vessel in High-Flow Intracranial Bypass Surgery”

The lateral intercostal artery perforator as an alternative donor vessel for free vascularized lymph node transplantation.

Chronic lymphedema is caused by an impairment of the lymphatic system due to primary or secondary causes. Vascularized lymph node transplantation (VLNT) is currently the most promising and frequently used technique besides lymphaticovenous anastomosis. However, the vessel anatomy in the lateral thoracic region is sometimes quite variable. Based on our experiences with vascular anatomical inconstancy in the lateral thoracic region, we planned a lateral intercostal artery perforator flap for VLNT in a female patient with chronic stage II lymphedema of both legs after cervical cancer treatment. After surgery, the patient reported significant improvement in limb volume and the accompanying symptoms. The limb circumference was reduced by an average of 19.2% at 6 months postoperatively. Despite having a short pedicle and small vessel caliber, the lateral intercostal artery perforator flap can safely be used for VLNT in lymphedema patients with anatomical variants.

Long-term Outcomes After Encephaloduroarteriosynangiosis in Adult Patients with Moyamoya Disease Presenting with Ischemia

In adult Moyamoya disease (MMD), there remains controversy about the effectiveness of revascularization surgeries because randomized studies have not been performed to compare the efficacy of surgical techniques. This study was conducted to assess the most appropriate surgical treatment for adult patients with MMD. Encephaloduroarteriosynangiosis (EDAS) was performed on 247 hemispheres in 145 patients. The clinical and demographic characteristics of patients were obtained via retrospective chart review. Clinical and angiographic states were evaluated retrospectively using quantitative methods. The mean duration of clinical follow up was 141.4 ± 19.5 months. A total of 247 EDAS procedures were performed in 145 patients, including 15 EDAS performed using the occipital artery as the donor vessel. The mortality rate was 0%, and the permanent morbidity rates were 1.2% per operation and 2.0% per person. The mean modified Rankin Scale score was 1.21 ± 1.31 postoperatively and 1.01 ± 1.39 at the last follow-up. Of the 109 hemispheres studied, 45% were classified as grade A, 34% as grade B, and 21% as grade C collateral circulation. The annual rates of stroke were calculated to be 0.73% per person-year. Overall, the 1-,5-, and 10-year actuarial stroke rates were 2.1±1.2%, 6.8±2.1%, and 8.9±2.4%, respectively. Bilateral involvement was a common significant factor in any, hemorrhagic, and ischemic strokes. Hypertension was a risk factor for ischemic strokes during follow-up. EDAS is an effective procedure in a Chinese cohort of patients with MMD. EDAS resulted in satisfactory long-term improvement of clinical states and prevention of recurrent strokes.

Issue Information

COVER PHOTOGRAPH: Whole mount immunostaining of HH29 stage avian embryonic chimeric heart (ventral view). Quail (donor) proepicardial‐derived vascular cells, labeled in red with the QH1 antibody, contribute to ventricular coronary blood vessel formation. Intravascular injection of Lens culinaris‐FITC (green) counterstains all donor and host coronary vessels and endocardial domains connected with the systemic flow. From: Avian embryonic coronary arterio‐venous patterning involves the contribution of different endothelial and endocardial cell populations; Paul Palmquist‐Gomes, Juan Antonio Guadix and José M. Pérez‐Pomares; Developmental Dynamics 247: pp 686–698.

Application of free superficial circumflex iliac artery perforator flap with end to side anastomosis for repair of hand skin and soft tissue defects

Objective To explore the clinical effects of free superficial circumflex iliac artery perforator flap with end to side anastomosis in the treatment of hand skin and soft tissue defects. Methods From January 2012 to December 2016, 26 cases of hand skin and soft tissue defects were treated by the transplantation of free superficial circumflex iliac artery perforator flap. The area of flap ranged from 5.0 cm×8.0 cm to 9.0 cm×20.0 cm. The superficial iliac circumflex artery and its accompanying vein were anastomosed to the ulnar artery or radial artery and its accompanying vein respectively by end-to-side suture technique. The superficial iliac circumflex vein was anastomosed with the cephalic vein or subcutaneous superficial vein by end-to-end suture technique. Results Postoperatively all the flaps survived uneventfully. The follow-up time was 3 to 18 months, with an average of 11 months. The texture of flap was soft with good blood supply. The fingers of injured limb were warm. Conclusion Free superficial circumflex iliac artery perforator flap with end to side anastomosis is an ideal method for repair of hand skin and soft tissue defects, which not only retains the main vessel of recipient area, but also solves the mismatching of the caliber of the flap pedicle vessel and recipient vessel. The flap transplantation is no longer limited by the caliber of donor and recipient vessels, and has high patency rate and low operation risk. Key words: Surgical flaps; Hand injuries; Superficial circumflex iliac artery; End-to-side anastomosis

Subclavian-to-Extracranial Vertebral Artery Bypass in a Patient With Vertebrobasilar Insufficiency: 3-Dimensional Operative Video.

Hemodynamic insufficiency from extracranial vertebral artery (VA) stenosis may be a primary cause for transient ischemic attacks in patients with vertebrobasilar insufficiency (VBI). Recent literature supports open or endovascular revascularization in selected patients. Although traditionally carotid-to-VA bypass was used to augment flow and alleviate symptoms of VBI, a subclavian artery (SA)-to-VA bypass avoids the risk of ischemic injury of the anterior intracranial circulation. We describe a SA-to-extracranial VA bypass in a 53-yr-old woman who presented with vertigo, dizziness, and syncope exacerbated by neck movements. An angiogram demonstrated complete bilateral proximal VA occlusions. The patient had collateral flow distally from muscular branches off the thyrocervical trunk and minimal flow through the anterior circulation. Neck movements appeared to reduce flow from the muscular branches, producing symptoms. Given the patient's symptoms, the radiographic findings, and the unsuitability of an endovascular procedure to augment flow, a left VA revascularization procedure was planned (either VA could have been the recipient for revascularization). Using an interposition saphenous vein (SV) graft (harvested by the cardiac surgical team), we augmented the posterior circulation with a left SA-to–VA (V3 segment) vascular bypass. The thyrocervical trunk was used as donor vessel because its caliber matches the SV graft and V3 segment. The horizontal part of the V3 segment was isolated in the J-groove of the C1 arch. Microsurgical end-to-end thyrocervical trunk-to-SV and end-to-side SV-to-VA anastomoses were performed, and flow was confirmed. Postoperative angiography showed patent flow through the graft and improved posterior circulation, with symptomatic improvement continuing at 6-mo follow-up. This report is exempt from informed consent. Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opx130 {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Subclavian-to-Extracranial Vertebral Artery Bypass in a Patient With Vertebrobasilar Insufficiency: 3-Dimensional Operative Video","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_r8guqjyl"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Disclosures Dr Taussky is a consultant for Covidien/ev3/Medtronic, unrelated to this work. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Impact of right atrial pressure on fractional flow reserve calculation in the presence of a chronic total occlusion.

The aim of this study was to assess the impact of right atrial pressure (Pra) on non-CTO vessels FFR measurements in patients with a chronic total occlusion. Consecutive patients who underwent PCI for a CTO of the right coronary artery (RCA) were included. Prior to RCA recanalization, FFR and FFRmyo were measured in non-CTO vessels. FFR was calculated using the Pd/Pa equation during maximum hyperaemia and also accounting for right atrial pressure (Pd-Pra/Pa-Pra). Non-CTO vessels were characterised as major or minor donors based on angiographic assessment of provided collaterals. FFR and FFRmyo were measured in 68 arteries (34 LAD and 34 Cx) in 34 consecutive patients with successful RCA CTO PCI. Patients' mean age was 62 ± 10 years old and 88% were male. Mean left ventricular ejection fraction was 51% ± 20. During maximum hyperaemia, mean Pra, Pa, and Pd were 4.1 ± 3.8 mm Hg, 82.6 ± 12.2 mm Hg, and 63.8 ± 14.3 mm Hg, respectively. In the major donor vessel, FFRmyo showed a difference of 0.007 to FFR (0.760 ± 0.113 vs. 0.767 ± 0.112, p = 0.004). In the minor donor vessel the difference was 0.004 (0.895 ± 0.067 vs. 0.899 ± 0.065, p < 0.001). There was a strong positive correlation between the FFR and FFRmyo in both the major and minor donor vessel groups (r = 0.993, p < 0.001 and r = 0.996, p < 0.001 respectively). In the presence of a CTO, RA pressure adjustment of FFR in the non-CTO vessels leads to trivial numerical changes, which are statistically significant but clinically negligible.

Internal Thoracic Artery to Middle Cerebral Artery Bypass Surgery: Cadaveric Feasibsility Study.

A few options of extracranial donor vessels exist for use in intracranial vascular bypass procedures. To our knowledge, the use of an internal thoracic artery for cerebral revascularization has not been studied previously. Hence, this cadaveric feasibility study was performed. The internal thoracic artery was dissected in 5 adult cadaveric specimens. The proximal diameter, distal diameter, and length of the vessel were measured and recorded. The artery was then transected distally at the seventh intercostal space and transposed cranially, through a pterional craniotomy opening to reach the middle cerebral artery at the skull base. The mean diameter of the internal thoracic artery at its proximal end was 3.5 mm and at its distal end was 2 mm. The average length of the vessel was 31 cm. There was no statistical difference between the measurements recorded from different sides or sexes. In each specimen, an internal thoracic artery was dissected, rotated superiorly, and advanced subcutaneously behind the ear to reach the middle cerebral artery at the skull base without difficulty and remained tensionless at the site of anastomosis. In this cadaveric study, we demonstrated the suitability of the internal thoracic artery in use as a donor vessel for a single site anastomosis in a high-flow cerebral bypass procedure.

Common and Uncommon CTO Complications.

Despite the ongoing development of technical skills, increasing operator experience and improvements in medical devices, percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) are still the most challenging procedures in interventional cardiology for coronary artery disease. Due to the complexity of the procedures, there is an increased complication rate compared with PCIs for the treatment of non-occlusive disease. This may significantly increase procedural morbidity and potentially mortality. CTO-PCI related complications include all the usual complications that are seen in routine PCI in addition to unique issues such as inadvertent occlusion of donor vessels or injury of collateral channels causing haemodynamic instability or ischaemia. To minimise the morbidity associated with these procedures, it is important to be aware of potential complications and recognise them in a timely fashion. Should they arise, operators should be able to deal with them in a safe and efficient manner.

Geometric Three-Dimensional End-to-Side Microvascular Anastomosis: A Simple and Reproducible Technique.

End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is critical. The ideal ETS microanastomosis should maintain a wide aperture and have a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity of the suture line. We have developed a unique, dependable, and reproducible geometric technique for ETS anastomoses, and analyze its efficacy in our series of patients. The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped defect on the recipient vessel wall, followed by a slit incision of the donor vessel to create a "spatula" fitting this defect. This technique removes sutures from the point of most turbulent blood flow while holding the recipient vessel open with a patch vesselplasty effect. We perform a retrospective review of a single surgeon's experience using this technique. The geometric 3D ETS technique was used in 87 free flaps with a total of 102 ETS anastomoses in a wide range of cases including head and neck, trunk and genitourinary, and extremity reconstruction. Overall, free flap success rates were 98%. The geometric 3D ETS technique creates a wide anastomosis, minimizes turbulence-inducing thrombogenicity, and mechanically holds the recipient vessel open. It is reliable and reproducible, and when performed properly has been shown to have high rates of success in a large group of free tissue transfer patients.

Mouse Model for Pancreas Transplantation Using a Modified Cuff Technique

Mouse models have several advantages in transplantation research, including easy handling, a variety of genetically well-defined strains, and the availability of the widest range of molecular probes and reagents to perform in vivo as well as in vitro studies. Based on our experience with various murine transplantation models, we developed a heterotopic pancreas transplantation model in mice with the intent to analyze mechanisms underlying severe ischemia reperfusion injury-associated early graft damage. In contrast to previously described techniques using suture techniques, herein we describe a new procedure using a non-suture cuff technique. In recent years, we have performed more than 300 pancreas transplantations in mice with an overall success rate of >90%, a success rate never described before in mouse pancreas transplantation. The backbone of this non-suture cuff technique for graft revascularization consists of two major steps: (I) pulling the recipient vessel over a polyethylene/polyamide cuff and fixing it with a circumferential ligature, and (II) placing the donor vessel over the everted recipient vessel and fixing it with a second circumferential ligature. The resultant continuity of the endothelial layer results in less thrombogenic lesions with high patency rates and, finally, high success rates. In this model, arterial anastomosis is achieved by pulling the abdominal aorta of the donor graft over the everted common carotid artery of the recipient animal. Venous drainage of the graft is achieved by pulling the portal vein of the graft over the everted external jugular vein of the recipient. This manuscript provides details and crucial steps of the organ recovery and organ implantation procedures, which will allow researchers with microsurgical skills to perform the transplantation successfully in their laboratories.

Mouse Model for Pancreas Transplantation Using a Modified Cuff Technique.

Mouse models have several advantages in transplantation research, including easy handling, a variety of genetically well-defined strains, and the availability of the widest range of molecular probes and reagents to perform in vivo as well as in vitro studies. Based on our experience with various murine transplantation models, we developed a heterotopic pancreas transplantation model in mice with the intent to analyze mechanisms underlying severe ischemia reperfusion injury-associated early graft damage. In contrast to previously described techniques using suture techniques, herein we describe a new procedure using a non-suture cuff technique. In recent years, we have performed more than 300 pancreas transplantations in mice with an overall success rate of >90%, a success rate never described before in mouse pancreas transplantation. The backbone of this non-suture cuff technique for graft revascularization consists of two major steps: (I) pulling the recipient vessel over a polyethylene/polyamide cuff and fixing it with a circumferential ligature, and (II) placing the donor vessel over the everted recipient vessel and fixing it with a second circumferential ligature. The resultant continuity of the endothelial layer results in less thrombogenic lesions with high patency rates and, finally, high success rates.In this model, arterial anastomosis is achieved by pulling the abdominal aorta of the donor graft over the everted common carotid artery of the recipient animal. Venous drainage of the graft is achieved by pulling the portal vein of the graft over the everted external jugular vein of the recipient. This manuscript provides details and crucial steps of the organ recovery and organ implantation procedures, which will allow researchers with microsurgical skills to perform the transplantation successfully in their laboratories.

Evaluation of Patency After Vascular Anastomosis Using Quantitative Evaluation of Visualization Time in Indocyanine Green Video Angiography.

In vascular reconstructive surgery, intraoperative confirmation of patency is performed by angiography, Doppler, or indocyanine videoangiography, but it is sometimes insufficient. Using the FLOW 800 system (Carl Zeiss, Oberkochen, Germany), we confirmed patency in a quantitative relative evaluation of the timing of the luminance change of the regions of interest (ROIs) on the donor and recipient. Thirty-seven patients (58 anastomoses) were divided into 2 groups: those with arteriosclerotic ischemic disease (CI group; n= 23) and those with cerebral aneurysm (AN group; n= 14). Four ROIs were set: the donor, proximal, and distal sides of the recipient middle cerebral artery (MCA) and cortical MCA (control MCA). The half-life for fluorescence intensity was calculated by using the FLOW 800 system. A delay map analysis was also performed. In the CI group, there were statistically significant differences (P < 0.05) between the donor vessel and control MCA, proximal MCA and MCA control, and distal MCA and control MCA. The investigation with the delay map showed red tones in 20/22 patients in the CI group and in 2/17 patients in the AN group. In the CI group, the transit time of the donor vessel was shown relatively early as red T. When good patency has been achieved, the FLOW 800 system can be used to confirm patency more reliably, especially in ischemic regions. The unique point of this research is that the patency of anastomotic vessels was evaluated as a quantitative value of its rendering time rather than as a change in fluorescence intensity.

Abdominal Wall Reconstruction Using an Anterolateral Thigh Free Flap for a Large Abdominal Wall Defect

Objective: To present a complicated case of abdominal wall reconstruction after tumor extirpation using an anterolateral thigh free flap. Methods: This is a report of a case managed at the Philippine General Hospital last September 2016. Results: A 25-year-old male, diagnosed case of recurrent colon adenocarcinoma, underwent wide excision of recurrent abdominal wall tumor with fistula, resulting to 15cm x 30cm full thickness soft tissue abdominal wall defect with exposed bowels. A free anterolateral thigh fasciocutaneous flap was designed and elevated to cover the abdominal wall defect. Recipient vessels (contralateral deep inferior epigastric artery and veins) were anastomosed with donor vessels (descending branch of lateral circumflex femoral artery and veins). The donor site was closed with split thickness skin grafting. Conclusion: The free anterolateral thigh flap allows for coverage of complicated recurrent abdominal wall malignancies, allowing for a single-stage surgery, with little donor site morbidity and shorter hospital stay. Key words: free tissue transfer flap, microsurgical free flap