From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center.
Plast Reconstr Surg. 2018 Sep;142(3):786-794. doi: 10.1097/PRS.0000000000004697.
Successful free tissue transfer requires tension-free microvascular anastomosis. Vein grafts are used when this cannot be obtained, which increases microsurgical complexity and the chance of vessel thrombosis. Previous studies on vein grafts are limited to low numbers and selected techniques, making it difficult to draw conclusions.
A retrospective chart review was performed for all patients who underwent vein grafts in free flap reconstruction from 1995 to 2015. Information on patient and flap characteristics, returns to the operating room, and flap loss was analyzed.
Seventy-two free flap reconstructions requiring 122 vein grafts were performed in the genitourinary/perineal (49 percent) and head and neck (38 percent) regions. The majority were performed in the initial operation (82 percent) and, of those, the majority were planned (71 percent). The most common vein graft types used were transposition arteriovenous loops (57 percent) and interpositions (26 percent). Of the initial cases, 22 percent returned to the operating room, resulting in a 7 percent total flap loss rate and a 7 percent partial flap loss rate. On univariate analysis, graft timing/planning, gap type, vein graft type, and reconstruction location were significantly associated with take-backs and flap loss. However, gap type and location seem to be strongly associated with graft timing/planning and vein graft type. Graft type and planning/timing do not have as strong a relationship and seem to independently relate to flap loss.
Vein grafts are more successful when planned and when performing transpositions and arteriovenous loops over interpositions. These graft types should be considered over interpositions when possible.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
成功的游离组织移植需要无张力的微血管吻合。当无法获得这种吻合时，需要使用静脉移植物，这会增加显微外科的复杂性和血管血栓形成的机会。以前关于静脉移植物的研究数量有限且仅限于特定技术，因此难以得出结论。
对 1995 年至 2015 年间所有接受游离皮瓣重建的患者进行静脉移植物的回顾性图表审查。分析患者和皮瓣特征、返回手术室和皮瓣丢失的信息。
72 例游离皮瓣重建术共使用 122 个静脉移植物，分别用于泌尿生殖/会阴（49%）和头颈部（38%）区域。大多数手术在初次手术中进行（82%），其中大多数为计划性手术（71%）。最常用的静脉移植物类型是转位动静脉环（57%）和插入术（26%）。在初次手术中，有 22%的患者返回手术室，导致总皮瓣丢失率为 7%，部分皮瓣丢失率为 7%。单因素分析显示，移植物时机/计划、间隙类型、静脉移植物类型和重建部位与再手术和皮瓣丢失显著相关。然而，间隙类型和部位似乎与移植物时机/计划和静脉移植物类型密切相关。静脉移植物类型和计划/时机之间的关系不那么密切，而且似乎独立于皮瓣丢失相关。
当计划进行时，以及当进行转位和动静脉环时，静脉移植物更成功。当可能时，应优先考虑这些移植物类型而不是插入术。
临床问题/证据水平：治疗性，IV 级。
