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Sulli D, S C, Rao A. In Search of Optimal Practice: A Retrospective Comparative Study of Single- Versus Dual-Venous Anastomosis in Microvascular Flaps. Cureus 2024; 16:e58573. [PMID: 38765325 PMCID: PMC11102574 DOI: 10.7759/cureus.58573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Background In the current era of reconstructive surgery, microvascular free flap transfers are the most popular reconstructive procedures performed. The main reason for the failure of the flap and re-exploration is venous thrombosis. Traditionally, most surgeons prefer performing two-vein anastomoses. There is insufficient literature to support that dual-venous anastomosis is better than single-venous anastomosis. In this study, we compared the success rate of single-venous anastomosis with dual-venous anastomosis of different free flap reconstructions. Methodology The retrospective cohort study was conducted with a total of 101 patients. Eighty-three were in the one-vein group, and the remaining 18 were in the two-vein group. Outcomes were compared between the two groups regarding re-exploration and flap failure. Results The overall success rate of free flap reconstruction was 96%. Among the 101 free flaps, 16 flaps had signs of venous compromise and were re-explored. Out of the 16 flaps, 11 flaps (13.2%) were in the one-vein group, and 5 flaps (27.7%) were in the two-vein group. In the two-vein group, 100% of the flaps were salvaged, and in the one-vein group, only 63% of the flaps were salvaged after re-exploration. There was no statistically significant difference between the one-vein group and the two-vein group concerning re-exploration. Conclusions The rate of re-exploration was lower in the one-vein group when compared to the two-vein group. However, this difference was not statistically significant. Hence, a single-vein anastomosis is sufficient for a successful microvascular free flap. However, the rate of flap salvage is better with two-vein anastomosis if there is venous congestion.
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Affiliation(s)
| | - Chandni S
- Plastic Surgery, Yenepoya Medical College, Mangalore, IND
| | - Amar Rao
- Surgical Oncology, Yenepoya Medical College, Mangalore, IND
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Muacevic A, Adler JR. One Versus Two Veins in Free Anterolateral Thigh Flap Reconstruction: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e32358. [PMID: 36628050 PMCID: PMC9826715 DOI: 10.7759/cureus.32358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/13/2022] Open
Abstract
There is considerable debate in the literature as to whether one or two venous anastomoses are optimal in the anterolateral thigh (ALT) free-flap reconstruction. The literature is currently devoid of a systematic review and meta-analysis of studies evaluating these procedures. This review will therefore be the first to address this clinical question. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors (EW and SR) independently searched the following electronic databases: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). Case-control, randomised control and observational studies were included. The authors did not include case reports, case series, letters or abstracts. All patients were included regardless of age, co-morbidity status, and the anatomical site of reconstruction. Venous congestion/thrombosis, flap take-back rate due to venous insufficiency, flap loss and operative time were the primary outcome measures. Secondary outcome measures included partial flap loss and haematoma formation. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. Review Manager 5.4 data synthesis software was used for the analysis. The authors identified eight observational studies, with a total of 1741 patients reviewed, demonstrating a significantly lower flap take-back rate for a double venous anastomosis and a shorter operative time in the single venous anastomosis group. However, other reported measures, including venous congestion and flap loss, showed a non-significant difference (P>0.05). The limitations of the evidence included in this review were that all studies were observational in design. The flap take-back rate is significantly less when anastomosing two veins, and the authors recommend that utilising a second vein can circumvent the caveat of venous compromise.
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Mata Ribeiro L, Tsao CK, Hung YL, Chu CH, Lin LC, Lin MH, Peng C, Cheong DCF, Hung SY, Liao CT. Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps. J Reconstr Microsurg 2022; 38:654-663. [PMID: 35213928 DOI: 10.1055/s-0042-1743165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Superficial temporal vessels have been used successfully as recipient vessels for head and neck reconstruction. This study evaluates the impact of several treatment variables on flap failure and take-back rate when using these recipient vessels. METHODS We conducted a retrospective study of all microsurgical reconstructions using superficial temporal vessels as recipient vessels in a period of 10 years. Variables collected included previous treatments (radiotherapy, chemotherapy, neck dissection, free flap reconstruction), type of flaps used (soft tissue, osteocutaneous), and vessel size discrepancy between donor and recipient vessels. RESULTS A total of 132 patients were included in the study. The flap success rate was 98.5%. The take-back rate was 10.6%. The most frequent reason for take-back was venous congestion secondary to thrombosis. None of the studied variables was associated with flap failure. Reconstructions using osteocutaneous flaps and vein diameter discrepancy (ratio ≥ 2:1) had significantly higher take-back rates. CONCLUSION Flaps with a significant size discrepancy between donor and recipient veins (ratio ≥ 2:1) and fibula flaps (compared with soft tissue flaps) were associated with a higher risk of take-back. It is crucial to minimize venous engorgement during flap harvest and anastomosis, and limit vein redundancy during flap in-setting.
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Affiliation(s)
- Luís Mata Ribeiro
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, São José Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Liang Hung
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Hui Chu
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Ching Lin
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mo-Han Lin
- Center of Tissue Engineering, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi Peng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
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Hand-sewn, coupler and Doppler-assisted venous anastomosis in free flap surgery: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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5
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Analysis of Selection of Recipient Vein, Number of Outflows, Style and Technique in Head and Neck Venous Anastomosis and a Proposed Algorithm. J Plast Reconstr Aesthet Surg 2020; 73:1825-1833. [PMID: 32571686 DOI: 10.1016/j.bjps.2020.05.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/01/2020] [Accepted: 05/09/2020] [Indexed: 11/22/2022]
Abstract
Surgeons have preferential ways of performing venous anastomosis in head and neck microsurgery. However, controversies exist regarding the superiority of each method. This study aims to determine the effects of these variables on the rates of thrombosis and flap failure, and propose an algorithm to be used as a facilitator in the decision-making process. A total of 208 microsurgical reconstructions on 199 patients from a single surgeon's data were evaluated. Selection of recipient vein (superficial vs. deep), style of anastomosis (end-to-end vs. end-to-side), number of outflows (one vs. two) and technique of anastomosis (hand-sewn vs. coupler) were compared. Selection was done according to the pre- and intraoperative plan, as well as, surgeon's clinical judgement. Outcomes were determined as rates of venous thrombosis and flap failure. Five patients (2.4%) had venous problems, leading to two partial and three total flap failures. Selection of the recipient vein, style and number of outflows did not affect the outcomes, whereas coupler use decreased the rates of venous thrombosis and flap failure (p=0.008). Although it is difficult to set dogmatic criteria to achieve consistent outcomes, coupler use in this study prevented flap failure. An algorithmic approach was proposed with the results of the data and literature to increase the success in microsurgical anastomosis. Surgeons should use algorithms and sound judgement with adherence to microsurgical principles to obtain the best results for each patient.
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Lin P, Kuo P, Kuo SCH, Chien P, Hsieh C. Risk factors associated with postoperative complications of free anterolateral thigh flap placement in patients with head and neck cancer: Analysis of propensity score‐matched cohorts. Microsurgery 2020; 40:538-544. [DOI: 10.1002/micr.30587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/26/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Pi‐Chieh Lin
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Pao‐Jen Kuo
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Spencer C. H. Kuo
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Peng‐Chen Chien
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Ching‐Hua Hsieh
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
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Abstract
BACKGROUND Venous compromise is still the most common cause of free flap failure. The need of a second venous anastomosis to prevent free flap failure is controversial. It is proposed that the use of dual venous anastomoses reduces venous compromise. However, some surgeons suggest that dual venous drainage reduces venous blood flow causing a potential risk of thrombosis. OBJECTIVE This study aimed to compare the frequency of reexploration secondary to venous thrombosis in free flap surgeries in reconstruction of soft tissue defects with 1-vein versus 2-vein anastomosis. MATERIALS AND METHODS We performed a retrospective cohort study including 298 flaps. In 180 of these patients, 2-vein anastomosis was done, and in 118, 1-vein anastomosis was done. The study was conducted at Aga Khan University Hospital from January 2017 to December 2018. RESULTS The number of venous anastomosis was not associated with flap survival. The group with dual anastomosis required more frequent reexploration as compared with 1 venous anastomosis group (8% vs 1.7%).Outcome and salvage rate were better in the 2-vein group as compared with the 1-vein group (64% vs 50%). CONCLUSION There is no difference in flap survival in single or dual venous anastomosis, but we have noticed higher reexploration rates in the 2-vein group. However, outcome is better in the 2-vein group.
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Abstract
Severe infections frequently cause large soft tissue defects which require early defect coverage by plastic surgeons. A number of reconstructive treatment options are available, ranging from local flaps to microvascular free flap reconstructions. In this respect it is important that the selection of the optimal reconstructive technique is made based on individual patient characteristics and in a timely manner. Weeks of inpatient treatment with vacuum dressings often delay defect coverage and should be avoided as they burden both the patient and the healthcare system. Therefore, it is in the best interest of patients to receive early treatment by plastic surgeons. This manuscript presents the essential reconstructive treatment approaches based on highly informative case reports of patients from the plastic surgical practice at a university hospital.
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Yin SC, Su XZ, So HI, Wang S, Zhang ZL, Xu ZF, Sun CF. Comparison of Internal Jugular Vein System Anastomosis and External Jugular Vein System Anastomosis in Free Flaps for Head and Neck Reconstruction: A Meta-Analysis. J Oral Maxillofac Surg 2019; 78:142-152. [PMID: 31550437 DOI: 10.1016/j.joms.2019.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/06/2019] [Accepted: 08/14/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of the present study was to investigate the differences in postoperative thrombosis and flap failure between internal jugular vein (IJV) system anastomosis and external jugular vein (EJV) system anastomosis in free flaps for the reconstruction of head and neck defects. MATERIALS AND METHODS We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database, and other databases until March 2019 for studies that had reported data for anastomosis for the 2 different venous systems in the microvascular free-flap reconstruction of head and neck defects. We assessed thrombosis and flap failure in patients undergoing anastomosis of the IJV system and patients undergoing anastomosis of the EJV system. RESULTS Nine studies with a total of 2051 patients with venous anastomosis were included in the present meta-analysis. IJV system anastomosis showed a significantly lower incidence of venous thrombosis than did the EJV system (relative risk [RR], 0.55; 95% confidence interval [CI], 0.37 to 0.82). Eight studies were included in the analysis of the flap failure rate, which showed a lower failure rate for the IJV system anastomosis than for the EJV system (RR, 0.59; 95% CI, 0.35 to 1.00). CONCLUSIONS The incidence of thrombosis and flap failure after venous anastomosis in the IJV system was lower than that in the EJV system. The results from the present study have shown that the IJV system should be the first choice for venous anastomosis in the reconstruction of free flaps.
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Affiliation(s)
- Shou-Cheng Yin
- Resident, Departments of Oral Maxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Xing-Zhou Su
- Resident, Departments of Oral Maxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Hyon Il So
- Professor, Department of Oral Maxillofacial Surgery, Pyongyang Medical College, Kim Il Sung University, Pyongyang, Democratic People's Republic of Korea
| | - Shuai Wang
- Resident, Departments of Oral Maxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Ze-Liang Zhang
- Resident, Departments of Oral Maxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Zhong-Fei Xu
- Professor, Departments of Oral Maxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China.
| | - Chang-Fu Sun
- Professor, Departments of Oral Maxillofacial-Head and Neck Surgery and Oral Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
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10
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Head and neck microsurgical reconstruction using the superficial temporal vein for antegrade and retrograde drainage: A clinical case series. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1479-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Numerical simulations of different configured venous anastomosis in microvascular flap transfer. J Craniomaxillofac Surg 2019; 47:792-797. [DOI: 10.1016/j.jcms.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 11/23/2022] Open
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12
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Matthews JLK, Alolabi N, Farrokhyar F, Voineskos SH. One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis. Plast Surg (Oakv) 2018; 26:91-98. [PMID: 29845046 DOI: 10.1177/2292550317740693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems. Methods A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs). Results Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27). Conclusions There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.
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Affiliation(s)
- Jennifer L K Matthews
- Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Noor Alolabi
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sophocles H Voineskos
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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13
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Christianto S, Lau A, Li K, Yang W, Su Y. One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis. Int J Oral Maxillofac Surg 2018; 47:585-594. [DOI: 10.1016/j.ijom.2018.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/24/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
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14
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Vascular Complications and Free Flap Salvage in Head and Neck Reconstructive Surgery. Ann Plast Surg 2017; 78:S83-S88. [DOI: 10.1097/sap.0000000000001011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Chaput B, Herlin C, de Bonnecaze G, Carloni R, Laloze J, Bertheuil N. One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation. Plast Reconstr Surg 2017; 139:807e-808e. [PMID: 28234880 DOI: 10.1097/prs.0000000000003101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Benoit Chaput
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital Toulouse, France
| | - Christian Herlin
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Guillaume de Bonnecaze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Raphael Carloni
- Department of Plastic and Hand Surgery, CHU Rouen, Rouen, France
| | - Jerome Laloze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Rangueil Hospital, Toulouse, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France
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Yang B, Qu Y, Su M, Li J, Li H, Xing R, Han Z. Characteristics and surgical management of flap compromise caused by thrombosis of the internal jugular vein. J Craniomaxillofac Surg 2017; 45:347-351. [DOI: 10.1016/j.jcms.2016.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/16/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022] Open
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17
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One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation. Plast Reconstr Surg 2017; 139:1215e. [PMID: 28098715 DOI: 10.1097/prs.0000000000003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Heidekrueger PI, Ehrl D, Heine-Geldern A, Ninkovic M, Broer PN. One versus two venous anastomoses in microvascular lower extremity reconstruction using gracilis muscle or anterolateral thigh flaps. Injury 2016; 47:2828-2832. [PMID: 27771041 DOI: 10.1016/j.injury.2016.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Free tissue transfers are a highly reliable procedure routinely performed for reconstruction of a wide range of defects. Main complication in free flap surgery is usually venous thrombosis. Many technical controversies exist regarding the technical details of the microvascular anastomosis in order to prevent occurrence of thrombosis and optimize outcomes. We therefore evaluated our results regarding the execution of one versus two venous anastomoses in a variety of free flaps (fasciocutaneous- or muscle free flap) utilized for lower limb reconstruction. PATIENTS AND METHODS Between 2009 and 2015, 354 patients underwent 386 free ALT- or gracilis flaps for lower limb defect reconstruction after trauma, infection, or malignancies at our institution. The data was retrospectively screened for patients' demographics, perioperative details, flap survival, and surgical complications. The cases were divided into two groups regarding the number of microsurgically performed venous anastomosis: one versus two veins. RESULTS Regarding the preoperative evaluation, there were no significant differences regarding comorbidities between the two groups. Overall, there was no significant difference regarding the rate of major (1 vein: 20.38% versus 2 veins: 18.78%, p>0.05) and minor (1 vein: 1.27% versus 2 veins: 2.18%, p>0.05) surgical complications during our 3-months follow-up period. Major complications included total flap losses of 5.73% (1 vein) versus 8.78% (2 veins). CONCLUSION This study analyzed a large series of microsurgical reconstructions, with a focus on the impact of the number of venous anastomosis. The findings suggest that successful free tissue transfer for lower limb reconstruction can be achieved independent of the number of venous anastomoses, however two should be performed when technically feasible.
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Affiliation(s)
- Paul I Heidekrueger
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany.
| | - Denis Ehrl
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany
| | - Albrecht Heine-Geldern
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany
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Lee SH, An SJ, Kim NR, Kim UJ, Kim JI. Reconstruction of Postburn Contracture of the Forefoot Using the Anterolateral Thigh Flap. Clin Orthop Surg 2016; 8:444-451. [PMID: 27904728 PMCID: PMC5114258 DOI: 10.4055/cios.2016.8.4.444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/03/2016] [Indexed: 11/06/2022] Open
Abstract
Background Severe forefoot deformities, particularly those involving the dorsum of the foot, cause inconvenience in daily activities of living including moderate pain on the dorsal aspect of the contracted foot while walking and difficulty in wearing nonsupportive shoes due to toe contractures. This paper presents clinical results of reconstruction of severe forefoot deformity using the anterolateral thigh (ALT) free flap. Methods Severe forefoot deformities were reconstructed using ALT flaps in 7 patients (8 cases) between March 2012 and December 2015. The mean contracture duration was 28.6 years. Results All the flaps survived completely. The size of the flaps ranged from 8 cm × 5 cm to 19 cm × 8 cm. The mean follow-up period was 10 months (range, 7 to 15 months). There was no specific complication at both the recipient and donor sites. There was one case where the toe contracture could not be completely treated after surgery. All of the patients were able to wear shoes and walk without pain. Also, the patients were highly satisfied with cosmetic results. Conclusions The ALT flap may be considered ideal for the treatment of severe forefoot deformity.
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Affiliation(s)
- Sang Hyun Lee
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Jin An
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nu Ri Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Um Ji Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeung Il Kim
- Department of Orthopedic Surgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Higashino T, Sakuraba M, Oshima A, Fujiki M, Miyamoto S. Single venous anastomosis versus dual venous anastomoses in free anterolateral thigh flap transfer: A cohort study. J Plast Reconstr Aesthet Surg 2016; 69:1313-5. [DOI: 10.1016/j.bjps.2016.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/13/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022]
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21
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One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation. Plast Reconstr Surg 2016; 138:481-489. [DOI: 10.1097/prs.0000000000002365] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Comparison of Single and Double Venous Anastomoses in Head and Neck Oncologic Reconstruction Using Free Flaps. Plast Reconstr Surg 2016; 137:1583-1594. [DOI: 10.1097/prs.0000000000002087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Razzano S, Esposito L, Schonauer F. The venae comitantes clipping test for the evaluation of the venous drainage of the radial forearm free flap. Microsurgery 2015; 36:647-650. [DOI: 10.1002/micr.22514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 07/28/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Sergio Razzano
- Department of Plastic, Reconstructive and Aesthetic Surgery Piazza Miraglia; Second University of Naples; Naples Italy
| | - Luigi Esposito
- Unit of Plastic, Reconstructive and Aesthetic Surgery; Federico II University; via S.Pansini 5 Naples Italy
| | - Fabrizio Schonauer
- Unit of Plastic, Reconstructive and Aesthetic Surgery; Federico II University; via S.Pansini 5 Naples Italy
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24
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Garg RK, Poore SO, Wieland AM, Sanchez R, Baskaya MK, Hartig GK. Recipient vessel selection in the difficult neck: Outcomes of external carotid artery transposition and end-to-end microvascular anastomosis. Microsurgery 2015; 37:96-100. [PMID: 26186688 DOI: 10.1002/micr.22448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/02/2015] [Accepted: 06/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Selection of recipient vessels for head and neck microvascular surgery may be limited in the previously dissected or irradiated neck. When distal branches of the external carotid artery (ECA) are unavailable, additional options for arterial inflow are needed. Here we propose high ligation of the ECA and transposition toward the lower neck as an alternative. METHODS After obtaining institutional approval, patients who underwent head and neck tumor resection and simultaneous free flap reconstruction were identified over a 5-year period. Patients whose recipient artery was listed in the operative report were included. Chart review was performed to identify patient demographics, operative details, and patient and flap complications. In cases where the ECA was used, the artery was traced distally with care taken to protect the hypoglossal nerve. The ECA was then divided and transposed toward the lower neck where an end-to-end microvascular anastomosis was performed. RESULTS The recipient artery used for head and neck microsurgery was available for 176 flaps, and the facial (n = 127, 72.2%) and external carotid (n = 19, 10.8%) arteries were most commonly used. There were 0 flap thromboses in the ECA group compared to 3 flap thromboses that occurred with other recipient arteries (P = 1.00). No cases of first bite syndrome or hypoglossal nerve injury were identified. CONCLUSIONS The ECA may be transposed toward the lower neck and used for end-to-end microvascular anastomosis without complication of hypoglossal nerve injury or first bite syndrome. This method may be considered an alternative in patients with limited recipient vessel options for head and neck microsurgery. © 2015 Wiley Periodicals, Inc. Microsurgery 37:96-100, 2017.
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Affiliation(s)
- Ravi K Garg
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Samuel O Poore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Aaron M Wieland
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Ruston Sanchez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Mustafa K Baskaya
- Department of Neurological Surgery, University of Wisconsin, Madison, WI
| | - Gregory K Hartig
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI
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25
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Dual venous drainage to 1 recipient vein in the anterolateral thigh flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e285. [PMID: 25674366 PMCID: PMC4323389 DOI: 10.1097/gox.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Chen YC, Scaglioni MF, Huang EY, Kuo YR. Utility of “open-Y” anastomosis technique in the use of superior thyroid artery as recipient vessel for head and neck reconstruction with free flap. Microsurgery 2015; 36:391-396. [DOI: 10.1002/micr.22384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 12/21/2014] [Accepted: 01/07/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Yen-Chou Chen
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Mario F. Scaglioni
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yur-Ren Kuo
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
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