Chen Wei F, Kung Yen-Ping, Kang Yu-Chuan, Lawrence W Thomas, Tsao Chung-Kan
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IW.
Microsurgery. 2014 Jul;34(5):377-83. doi: 10.1002/micr.22214. Epub 2013 Dec 26.
The necessity of a second venous anastomosis in free tissue transfer is controversial. We review a single surgeon's 8-year experience of head and neck reconstruction using free anterolateral flap reconstruction to assess the need for a second venous anastomosis.
Three hundred and fifteen cases were included in the study after selecting only for anterolateral thigh flap, head, and neck reconstruction, and those that used superior thyroid artery as recipient. The selection criteria were designed to create as homogeneous a group as possible to decrease confounding factors.
The group with single anastomosis required more frequent take-backs than the group with dual anastomoses (19% vs 10.8%, P = 0.055). The trend persisted when only take-backs for venous insufficiencies were compared (8.2% vs 2.5%, P = 0.039). When flaps with single anastomosis developed venous congestion, they were more likely to require operative salvage for venous insufficiency than those with dual anastomoses (35.5% vs. 6.3%, P = 0.037). No difference was found in postoperative complications and flap survival.
Our data suggest that flaps with single venous anastomosis are more likely to require take-back for flap salvage than those with dual anastomoses.
在游离组织移植中进行第二次静脉吻合的必要性存在争议。我们回顾了一位外科医生使用游离股前外侧皮瓣重建进行头颈部重建的8年经验，以评估是否需要进行第二次静脉吻合。
本研究纳入了315例患者，这些患者均仅选用股前外侧皮瓣进行头颈部重建，并以甲状腺上动脉作为受区血管。选择标准旨在尽可能使研究组同质化，以减少混杂因素。
单吻合组的皮瓣回植率高于双吻合组（19% 对10.8%，P = 0.055）。仅比较静脉功能不全导致的皮瓣回植情况时，这一趋势仍然存在（8.2% 对2.5%，P = 0.039）。当单吻合皮瓣出现静脉淤血时，与双吻合皮瓣相比，其因静脉功能不全而需要手术挽救的可能性更大（35.5% 对6.3%，P = 0.037）。术后并发症和皮瓣存活率方面未发现差异。
我们的数据表明，与双吻合皮瓣相比，单静脉吻合皮瓣更有可能因皮瓣挽救而需要回植。
