Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia.
Department of Medicine, Melbourne University, Parkville, VIC 3052, Australia.
J Reconstr Microsurg. 2014 Jul;30(6):413-8. doi: 10.1055/s-0034-1372368. Epub 2014 Jun 24.
Various reports suggest the augmentation of venous drainage through performing two venous anastomoses as a means of reducing the rate of thrombosis in free flap surgery. However, some suggest dual venous drainage may actually reduce venous blood flow velocity causing a potential risk for thrombosis.
On the basis of the Preferred Reporting Items for Systematics Reviews and Meta-analysis statement, a systematic search was conducted using PubMed and Medline databases. A total of 12,190 articles relating to "free flaps" and "one versus two venous anastomoses" were found between January 1992 and November 2012. Of the 12,190 articles, 23 studies were included in a meta-analysis performed using STATA 11.2 (StrataCorp, College Station, TX). Studies with case control groups for both single and double venous anastomoses and clearly defined results for flap failure and venous thrombosis were included. 95% confidence interval (CI) were calculated for each study and pooled in both fixed and random-effects models for both flap failure and venous thrombosis events.
The analysis shows a significant reduction in flap failure (risk ratio, 0.64; 95% CI, 0.41-0.99; p = 0.03) and venous thrombosis (risk ratio, 0.66; 95% CI, 0.46-0.97; p = 0.047) when performing two venous anastomoses compared with one in free flap surgery.
The results show that performing two venous anastomoses is associated with a reduction in the incidence of flap failure by 36% and venous thrombosis by 34% compared with one venous anastomoses. Given that the performing of an additional venous anastomoses confers a lower risk of complication and is technically feasible, where possible two venous anastomoses should be performed in free flap procedures, however, this should be decided on a flap by flap basis.
多项报告表明，通过进行两个静脉吻合术来增加静脉引流，可以降低游离皮瓣手术中的血栓形成率。然而，有人认为双静脉引流实际上可能会降低静脉血流速度，从而带来潜在的血栓形成风险。
根据系统评价和荟萃分析的首选报告项目声明，使用 PubMed 和 Medline 数据库进行了系统搜索。在 1992 年 1 月至 2012 年 11 月期间，共找到了 12190 篇与“游离皮瓣”和“一个与两个静脉吻合术”相关的文章。在这 12190 篇文章中，有 23 项研究被纳入使用 STATA 11.2（StrataCorp，College Station，TX）进行的荟萃分析。纳入了单和双静脉吻合术的病例对照研究组，以及明确的皮瓣失败和静脉血栓形成结果。对每个研究进行了 95%置信区间（CI）的计算，并在固定和随机效应模型中对皮瓣失败和静脉血栓形成事件进行了汇总。
分析显示，与单静脉吻合术相比，在游离皮瓣手术中进行两个静脉吻合术可显著降低皮瓣失败（风险比，0.64；95%CI，0.41-0.99；p=0.03）和静脉血栓形成（风险比，0.66；95%CI，0.46-0.97；p=0.047）的发生率。
结果表明，与单静脉吻合术相比，进行两个静脉吻合术可使皮瓣失败的发生率降低 36%，静脉血栓形成的发生率降低 34%。由于进行额外的静脉吻合术可以降低并发症的风险，并且在技术上是可行的，因此在可能的情况下，应在游离皮瓣手术中进行两个静脉吻合术，但这应根据皮瓣的情况而定。
