Zhang Tao, Lubek Joshua, Salama Andrew, Caccamese John, Coletti Domenick, Dyalram Donita, Ord Robert
Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
J Oral Maxillofac Surg. 2012 Apr;70(4):992-6. doi: 10.1016/j.joms.2011.02.111. Epub 2011 Jul 13.
This study is a retrospective review of the experience using the venous coupler for head and neck reconstruction over a 3-year period at the University of Maryland Medical Center, Department of Oral and Maxillofacial Surgery.
One hundred seventy-eight consecutive cases of microvascular free flaps between May 2007 and September 2010 were retrospectively reviewed. Data were collected by demographic information, flap type, recipient vessels, method of anastomosis, coupler size, coupler orientation, complications associated with coupler, and reconstruction results. Fisher exact test was used for statistical analysis.
There were 294 anastomotic coupler devices used in 173 flaps, with hand-sewn venous anastomoses performed in 5 patients. The overall flap success rate was 94.9% (169/178). Success rate among cases in which the coupler was used was 95.4% (8/173). Total coupler venous thrombosis rate was 4.0% (7/173), with a statistically significant difference (P < .05) in reference to the number of venous anastomoses performed: 58 cases had a single vein anastomosed, 5 cases developed thrombosis; while the 115 flaps with 2 venous anastomoses, only 2 cases had thrombosis.
The microvascular coupler is reliable for venous anastomosis in free flap head and neck reconstruction; dual-vein anastomoses appear to have better results than single-vein anastomoses. Flow coupler has a promising utility in monitoring buried flaps and flaps that are difficult to observe. The microvascular coupler deserves to be more commonly used in free flap head and neck reconstruction.
本研究是对马里兰大学医学中心口腔颌面外科在3年时间里使用静脉吻合器进行头颈部重建的经验进行回顾性分析。
对2007年5月至2010年9月期间连续的178例微血管游离皮瓣病例进行回顾性分析。通过人口统计学信息、皮瓣类型、受区血管、吻合方法、吻合器尺寸、吻合器方向、与吻合器相关的并发症以及重建结果收集数据。采用Fisher精确检验进行统计学分析。
173例皮瓣使用了294个吻合器装置，5例患者采用手工缝合静脉吻合。皮瓣总体成功率为94.9%（169/178）。使用吻合器的病例成功率为95.4%（8/173）。吻合器静脉血栓形成总发生率为4.0%（7/173），与静脉吻合数量相比差异有统计学意义（P <.05）：58例进行单静脉吻合，5例发生血栓形成；而115例进行双静脉吻合的皮瓣中，仅2例发生血栓形成。
微血管吻合器在游离皮瓣头颈部重建的静脉吻合中可靠；双静脉吻合似乎比单静脉吻合效果更好。流量吻合器在监测埋藏皮瓣和难以观察的皮瓣方面具有良好的应用前景。微血管吻合器值得在游离皮瓣头颈部重建中更广泛地应用。
