23.  How does reverse flow work?  (PRS 1997; 100:1780)

Answer:
This report investigates the use of the distal ends of arteries as possible recipients of microvascular anastomoses. The retrograde arterial pressures were measured from the distal ends of the superior thyroid, facial, and radial arteries. They found that the mean retrograde arterial pressures were 50-60 percent of normal arterial pressure. Based on the knowledge that the radial artery can support a skin flap through retrograde or reverse flow (reverse radial forearm flap), it was concluded that the superior thyroid and facial arteries could also support flaps based on reverse flow. They report on 14 clinical cases in which this was done with no failures. The rationale is that in certain situations, like the superior thyroid artery in head and neck reconstructions, the geometry of the distal end may be less likely to kink and thrombose after microvascular anastomoses.
 

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