Khaja Sobia F, Rubin Nathan, Bayon Rodrigo
1 Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
2 Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.
Ann Otol Rhinol Laryngol. 2017 Oct;126(10):722-726. doi: 10.1177/0003489417728089. Epub 2017 Sep 1.
The purpose of this study was to compare rates of reexploration and flap failure in patients with 1- and 2-vein anastomoses in free flap reconstructions.
Retrospective chart review of 300 patients undergoing free flap reconstruction to head and neck defects from 2010 to 2014.
One venous anastomosis was performed in 229 patients, and 2 venous anastomoses were performed in 71 patients. The 1-vein group had significantly more reexplorations in the operating room (36/229, 15.7%) compared with the 2-vein group (4/71, 5.6%; P = .028), even when controlling for flap type ( P = .022). This finding remained true among radial forearm flaps (17/81, 21% vs 3/53, 5.7%; P = .024). The number of venous anastomoses was not significantly associated with flap failure, though patients with flap failure did have a significantly greater proportion of venous issues ( P < .001).
Two-vein anastomoses do not appear to reduce rates of flap failure or postoperative venous thrombosis but are associated with a lower number of reexplorations in the operating room even after accounting for differences in flap types and surgeons.
本研究旨在比较游离皮瓣重建中采用单静脉和双静脉吻合的患者再次手术探查率和皮瓣失败率。
对2010年至2014年接受游离皮瓣重建头颈部缺损的300例患者进行回顾性病历审查。
229例患者进行了单静脉吻合，71例患者进行了双静脉吻合。单静脉组在手术室进行再次手术探查的次数显著多于双静脉组（229例中有36例，占15.7%，而71例中有4例，占5.6%；P = 0.028），即使在控制皮瓣类型后也是如此（P = 0.022）。在前臂桡侧皮瓣中这一发现依然成立（81例中有17例，占21%，而53例中有3例，占5.7%；P = 0.024）。静脉吻合的数量与皮瓣失败无显著相关性，不过皮瓣失败的患者静脉问题的比例确实显著更高（P < 0.001）。
双静脉吻合似乎并未降低皮瓣失败率或术后静脉血栓形成率，但即使在考虑皮瓣类型和外科医生的差异后，双静脉吻合与手术室再次手术探查次数较少相关。
