Nelson Jonas A, Fischer John P, Grover Ritwik, Kovach Stephen J, Low David W, Kanchwala Suhail K, Levin L Scott, Serletti Joseph M, Wu Liza C
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
J Plast Reconstr Aesthet Surg. 2015 Jun;68(6):830-6. doi: 10.1016/j.bjps.2015.02.008. Epub 2015 Feb 18.
There is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique.
All microsurgical cases at a single institution from 2005 to 2011 were examined for use of IVGs in the primary procedure or during take back or salvage attempts. We examined the cohort overall and performed a subgroup analysis by timing of initial IVG.
In the study period, 1718 patients underwent 2368 free flaps. 51 IVGs were utilized in 38 patients (2.2%) and 38 flaps (1.6%). Eight (42.1%) of the primary procedure IVGs (n = 19) were planned preoperatively. Nine total flap losses (24%) occurred when IVGs were utilized, 89% of which occurred in the take back cohort (p = 0.02). However, planned IVG had a 100% success rate, and IVG utilized in the primary procedure overall had a 95% success rate. Importantly, A significantly higher rate of thrombotic events was noted in all primary cases where IVGs were utilized (p = 0.005).
This study demonstrates that IVGs can be utilized in primary free flap reconstructions with success rates exceeding 95%. However, in salvage procedures, the use of vein grafts does not approach the same rate of success likely due to multiple factors. Yet when utilized appropriately with thrombectomy and resection of the thrombosed vessel to healthy intima, IVGs can provide an important tool for flap salvage.
prognostic/risk category, level II.
关于在显微外科手术中使用间置静脉移植物（IVG）的适应症、结果及相关并发症的数据有限。本研究旨在严格审查并更新这种显微外科技术的效用。
对某单一机构2005年至2011年的所有显微外科病例进行检查，以确定在初次手术、二次手术或挽救手术中是否使用了IVG。我们对整个队列进行了检查，并根据初次使用IVG的时间进行了亚组分析。
在研究期间，1718例患者接受了2368例游离皮瓣手术。38例患者（2.2%）和38个皮瓣（1.6%）使用了51个IVG。19例初次手术使用的IVG中有8例（42.1%）是术前计划好的。使用IVG时共发生9例皮瓣丢失（24%），其中89%发生在二次手术队列中（p = 0.02）。然而，计划使用的IVG成功率为100%，初次手术总体使用IVG的成功率为95%。重要的是，在所有使用IVG的初次手术病例中，血栓形成事件的发生率显著更高（p = 0.005）。
本研究表明，IVG可用于初次游离皮瓣重建，成功率超过95%。然而，在挽救手术中，由于多种因素，静脉移植物的成功率未达到相同水平。然而，当与血栓切除术和将血栓形成的血管切除至健康内膜适当结合使用时，IVG可为挽救皮瓣提供重要工具。
预后/风险类别，二级。
