Division of Plastic Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 10 Penn Tower, Philadelphia, PA 19104, USA.
Plast Reconstr Surg. 2010 Mar;125(3):792-8. doi: 10.1097/PRS.0b013e3181cb636d.
Microvascular anastomosis is one of the more critical aspects of free flap surgery. A safe, effective, and expedient method for venous anastomosis minimizes flap ischemia time, is easier on the surgical team, and saves costly operating room time. The authors report on their experience using the Synovis microvascular anastomotic coupling device in 1000 consecutive venous anastomoses in free flap breast reconstruction.
The authors retrospectively reviewed 1000 consecutive venous anastomoses that were performed using the microvascular anastomotic coupler between July of 2002 and July of 2008. Data were obtained on flap type, recipient vessel, coupler size, incidence of venous thrombosis, timing of venous thrombosis, and morbidity as a result of venous thrombosis.
All anastomoses were performed in an end-to-end fashion. There were 460 unilateral cases and 270 bilateral cases of breast reconstruction. Flap types included muscle-sparing free transverse rectus abdominis myocutaneous, deep inferior epigastric perforator, superficial inferior epigastric artery, superior gluteal artery perforator, and inferior gluteal artery perforator. The vast majority of the recipient vessels were the internal mammary or thoracodorsal vessels. Most of the couplers that were used were either 3 or 2.5 mm in diameter. Overall, there were six instances of venous thrombosis (rate of 0.6 percent). There were no total flap losses due to venous thrombosis in this series, although two patients had partial flap necrosis.
The patency rate for venous anastomoses performed with the microvascular coupler is excellent when compared with standard suture techniques and has the advantage of overall easier application.
微血管吻合是游离皮瓣手术中较为关键的环节之一。安全、有效且便捷的静脉吻合方法可最大限度地减少皮瓣缺血时间，便于手术团队操作，并节省宝贵的手术室时间。作者报告了他们在 1000 例游离皮瓣乳房重建中使用 Synovis 微血管吻合对接装置进行静脉吻合的经验。
作者回顾性分析了 2002 年 7 月至 2008 年 7 月期间使用微血管吻合对接器进行的 1000 例连续静脉吻合术。记录皮瓣类型、受区血管、对接器大小、静脉血栓形成的发生率、静脉血栓形成的时间以及静脉血栓形成导致的发病率。
所有吻合均采用端对端吻合。单侧乳房重建 460 例，双侧乳房重建 270 例。皮瓣类型包括肌皮瓣游离横形腹直肌肌皮瓣、腹壁下动脉穿支皮瓣、胸背动脉、臀上动脉穿支皮瓣和臀下动脉穿支皮瓣。受区血管绝大多数为内乳动脉或胸背动脉。对接器的直径主要为 3 或 2.5mm。总体而言，有 6 例发生静脉血栓形成（发生率为 0.6%）。本系列中，虽有 2 例患者发生部分皮瓣坏死，但无因静脉血栓形成导致的全皮瓣坏死。
与标准缝线技术相比，使用微血管对接器进行静脉吻合的通畅率极佳，且具有操作更简便的总体优势。
