Numajiri Toshiaki, Morita Daiki, Tsujiko Shoko, Nakamura Hiroko, Sowa Yoshihiro, Arai Akihito, Masahiro Matsui, Nakano Hiroshi, Hirano Shigeru
Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; and Department of Otorhinolaryngology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2017 Aug 24;5(8):e1448. doi: 10.1097/GOX.0000000000001448. eCollection 2017 Aug.
The optimum number of microvascular anastomoses for safe free tissue transfer is controversial. Although the case for 2 venous anastomoses versus 1 anastomosis has been argued, the use of an additional arterial anastomosis has not been examined in detail.
Twelve patients who underwent 2 arterial anastomoses for a free flap transfer were identified retrospectively from the medical records of patients undergoing reconstruction for head and neck cancer. The free flaps were limited to anterolateral thigh (ALT) flaps.
All flaps survived. Complications included venous thrombosis (n = 1), reexploration (n = 1), and leakage (n = 3). The vascular patterns of dual-arterialized ALT flaps were classified into 3 groups. Types 1 and 2 were ALT flaps that had 2 vascular sources from the descending and lateral branches of the lateral circumflex femoral artery. The number of accompanying veins differed between type 1 (3 veins) and type 2 (2 veins). Type 3 differed from a conventional ALT flap nourished by the descending branch of the lateral circumflex femoral artery (1 vein) by the addition of anastomosis of an artery branching from the descending branch to the vastus medialis muscle. The total operation times for these 3 types of ALT were similar.
An additional arterial anastomosis to the free cutaneous flap did not cause any congestion or disturb the balance between inflow and outflow. If the surgeon considers that the first arterial anastomosis is unreliable, an additional anastomosis might be an option in ALT transfer.
安全进行游离组织移植时，微血管吻合的最佳数量存在争议。尽管对于2条静脉吻合与1条静脉吻合的情况已有讨论，但额外增加一条动脉吻合的应用尚未得到详细研究。
从接受头颈癌重建手术患者的病历中，回顾性确定12例行游离皮瓣移植且进行了2条动脉吻合的患者。游离皮瓣仅限于股前外侧（ALT）皮瓣。
所有皮瓣均存活。并发症包括静脉血栓形成（n = 1）、再次探查（n = 1）和渗漏（n = 3）。双动脉化ALT皮瓣的血管模式分为3组。1型和2型是具有来自旋股外侧动脉降支和外侧支2个血管来源的ALT皮瓣。1型（3条静脉）和2型（2条静脉）的伴行静脉数量不同。3型与由旋股外侧动脉降支供血的传统ALT皮瓣（1条静脉）不同，它增加了一条从降支分支至股内侧肌动脉的吻合。这3种类型ALT皮瓣的总手术时间相似。
对游离皮瓣额外增加一条动脉吻合不会导致任何充血，也不会干扰流入和流出之间的平衡。如果外科医生认为首次动脉吻合不可靠，那么在ALT皮瓣移植中额外增加一条吻合可能是一种选择。
