改良 Kunlin 法显微端端吻合术：100 例皮瓣系列报告。

Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps.

机构信息

Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.

出版信息

J Reconstr Microsurg. 2019 Jul;35(6):430-437. doi: 10.1055/s-0039-1677797. Epub 2019 Jan 25.

DOI:10.1055/s-0039-1677797

PMID:30682729

Abstract

BACKGROUND

In 1949, a French vascular surgeon, Jean Kunlin, first described a venous end-to-side anastomotic technique to address large vessel size mismatches. It was later modified by Dr. Robert Linton for end-to-end (ETE) anastomoses on the "macrovascular" scale. While multiple procedures exist for addressing moderate caliber discrepancies, few safely and reliably compensate for marked diameter differences at the microvascular level. In this study, we present the first large series adapting a modified geometric Kunlin's technique for arterial and venous ETE anastomoses in reconstructive microsurgery.

METHODS

We reviewed 100 consecutive cases of free flap reconstructions from 2006 to 2015 utilizing a modified geometric Kunlin's technique for arterial and venous ETE anastomoses. Patient demographics and flap outcomes were analyzed. Overall flap survival rates and postoperative complications were analyzed and compared with standard values in the microsurgical literature.

RESULTS

A total of 146 ETE anastomoses from 100 free flaps were analyzed. The average patient age was 51 ± 3.1 years (range: 10-84 years). Free flaps in this study were used for gender confirmation phalloplasties (20%) and reconstructing defects of the head and neck (63%), extremities (16%), and trunk (1%). There was a total of 17 takebacks including 5 for hematoma, 8 for anastomotic thromboses (6 venous), and 4 without any identifiable complication. Of these takebacks, two partial and two complete flap losses occurred. There was an 88% salvage rate for flaps requiring takebacks during the postoperative period. Overall, flap survival rate was 98% including those with complications or takebacks.

CONCLUSION

The modified Kunlin's technique is a reliable, facile, and versatile method of performing ETE anastomoses for arterial and venous vessels, especially with vessel diameter mismatches of 3:1 or greater, as well as for challenging orientations. Notably, it provides equivalent flap survival and complication rates as compared with other techniques in the microsurgical literature.

摘要

背景

1949 年，法国血管外科医生让·库林（Jean Kunlin）首次描述了一种静脉端侧吻合技术，以解决大血管尺寸不匹配的问题。后来，罗伯特·林顿（Robert Linton）博士对“大血管”尺度的端端吻合进行了修改。虽然有多种手术方法可用于解决中等口径差异问题，但很少有方法能够安全可靠地补偿微血管水平的显著直径差异。在这项研究中，我们首次报道了一种改良的几何库林（geometric Kunlin's）技术，用于重建显微外科中的动脉和静脉端端吻合。

方法

我们回顾了 2006 年至 2015 年期间 100 例连续的游离皮瓣重建病例，这些病例均采用改良的几何库林（geometric Kunlin's）技术进行动脉和静脉端端吻合。分析了患者的人口统计学和皮瓣结果。分析并比较了总体皮瓣存活率和术后并发症与显微外科文献中的标准值。

结果

共分析了 100 例游离皮瓣中的 146 个端端吻合。患者的平均年龄为 51±3.1 岁（范围：10-84 岁）。本研究中的游离皮瓣用于性别确认阴茎再造术（20%）和头颈部（63%）、四肢（16%）和躯干（1%）的缺损重建。共有 17 例皮瓣需要再次切开，其中 5 例因血肿，8 例因吻合口血栓形成（6 例静脉），4 例无任何可识别的并发症而需要再次切开。在这些需要再次切开的病例中，有 2 例部分皮瓣和 2 例完全皮瓣丢失。术后需要再次切开的皮瓣有 88%的存活率。总的来说，包括有并发症或需要再次切开的皮瓣，皮瓣存活率为 98%。