Stranix John T, Anzai Lavinia, Mirrer Joshua, Hambley William, Avraham Tomer, Saadeh Pierre B, Thanik Vishal, Levine Jamie P
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, New York.
Division of Plastic Surgery, Department of Surgery, Mount Sinai Health System and Icahn School of Medicine, New York, New York.
J Surg Res. 2016 May 15;202(2):235-8. doi: 10.1016/j.jss.2016.03.001. Epub 2016 Mar 10.
Venous outflow problems are the most common reasons for perioperative flap complications. The benefit of a second venous anastomosis, however, remains unclear in lower extremity trauma free flap reconstruction and warrants further investigation.
Retrospective review of our institutional flap registry from 1979 to 2014 identified 464 free flaps performed for lower leg trauma reconstruction. Patient demographics, flap characteristics, and outcomes were examined.
A total of 219 flaps were randomly selected for preliminary analysis. Single-vein outflow was more common (72.6%) than dual-vein (27.4%); most of the recipients were in deep venous system (83.6%) versus superficial (11.9%) or both (4.6%). Two-vein anastomoses were more likely in fasciocutaneous flaps than muscle flaps (P = 0.001) and in smaller (<300 cm(2)) flaps (P = 0.002). Complications occurred in 98 flaps (44.7%); with 54 partial flap losses (24.7%), and 11 complete flap losses (5.0%). Multivariable regression analysis controlling for age, sex, flap type, presence of bone gap, flap size, vein size mismatch, and time since injury demonstrated dual-vein outflow to be protective against complications (relative risk [RR] = 0.269, P = 0.001), partial flap failure (RR = 0.351, P = 0.031), and any flap failure (RR = 0.31, P = 0.010). No significant difference in operative time was found (P = 0.664).
Dual-vein outflow demonstrated 73% reduction in overall complications and 69% reduction in flap failure rate compared to single-vein flaps. These results suggest a protective effect of a dual-vein outflow system, and when considered together with our findings of unchanged operative time, provide evidence for preferential use of two venous anastomoses when possible for free flap reconstruction of lower extremity trauma.
静脉流出道问题是围手术期皮瓣并发症最常见的原因。然而，在下肢创伤游离皮瓣重建中，二次静脉吻合的益处仍不明确，值得进一步研究。
回顾性分析我院1979年至2014年皮瓣登记资料，确定464例因小腿创伤重建而进行的游离皮瓣手术。对患者的人口统计学资料、皮瓣特征及手术结果进行分析。
共随机选取219例皮瓣进行初步分析。单静脉流出道比双静脉流出道更常见（72.6%比27.4%）；大多数受区静脉位于深静脉系统（83.6%），而非浅静脉系统（11.9%）或两者皆有（4.6%）。筋膜皮瓣比肌皮瓣更可能进行双静脉吻合（P = 0.001），且在较小（<300 cm²）皮瓣中更常见（P = 0.002）。98例皮瓣（44.7%）出现并发症；其中54例皮瓣部分坏死（24.7%），11例皮瓣完全坏死（5.0%）。多因素回归分析校正年龄、性别、皮瓣类型、骨缺损情况、皮瓣大小、静脉大小不匹配及受伤时间后，显示双静脉流出道可预防并发症（相对危险度[RR]=0.269，P = 0.001）、皮瓣部分坏死（RR = 0.351，P = 0.031）及任何皮瓣坏死（RR = 0.31，P = 0.010）。手术时间无显著差异（P = 0.664）。
与单静脉皮瓣相比，双静脉流出道使总体并发症减少73%，皮瓣坏死率降低69%。这些结果提示双静脉流出道系统具有保护作用，结合手术时间无变化的研究结果，为下肢创伤游离皮瓣重建时尽可能优先采用双静脉吻合提供了依据。
