From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2019 May;143(5):1522-1529. doi: 10.1097/PRS.0000000000005552.
The Gustilo classification serves as a proxy for injury severity, but recent data suggest rising complications with decreasing arterial runoff. This study aims to compare different microsurgical anastomosis options based on the number of patent vessels in the lower extremity.
A single-center retrospective review of 806 lower extremity free flaps performed from 1976 to 2016 was performed. Patients with Gustilo type IIIB injuries were grouped based on the number of patent vessels in the leg (three, two, or one). Patients were compared based on the type of anastomosis performed, evaluating for perioperative complications and flap failures.
Perioperative complications occurred in 111 flaps (27 percent): 71 take-backs (17 percent), 45 partial losses (11 percent), and 37 complete losses (9 percent). Among patients with three-vessel runoff (61.8 percent), there was no difference in take-backs or flap loss between those with end-to-end versus end-to-side anastomoses. In 68 patients (18.7 percent) with two-vessel runoff, no difference between take-backs or flap loss was noted when comparing any anastomosis (i.e., end-to-end into an injured vessel, end-to-end into an uninjured vessel, or end-to-side into an uninjured vessel), although vein grafts were required more often in the end-to-side groups (p < 0.01). Finally, in 39 patients (10.7 percent) with single-vessel runoff, no difference was seen between end-to-end anastomosis into an injured vessel or end-to-side anastomosis into an uninjured vessel in terms of take-backs or flap loss.
Higher rates of flap failure correlated with decreasing numbers of patent vessels in the leg, but neither type of microvascular anastomosis nor vessel selection demonstrated any impact on reconstructive outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Gustilo 分类可作为损伤严重程度的替代指标，但最近的数据表明，随着动脉流出减少，并发症的发生率正在上升。本研究旨在比较基于下肢通畅血管数量的不同显微吻合术选择。
对 1976 年至 2016 年期间进行的 806 例下肢游离皮瓣进行了单中心回顾性研究。根据腿部通畅血管的数量（3 根、2 根或 1 根）将 Gustilo Ⅲ B 型损伤患者分组。根据所进行的吻合术类型对患者进行比较，评估围手术期并发症和皮瓣失败情况。
111 个皮瓣（27％）发生围手术期并发症：71 个再手术（17％），45 个部分损失（11％），37 个完全损失（9％）。在有三血管流出的患者中（61.8％），端端吻合与端侧吻合之间在再手术或皮瓣丢失方面无差异。在 68 例（18.7％）有两血管流出的患者中，当比较任何吻合术（即端端吻合入受伤血管、端端吻合入未受伤血管或端侧吻合入未受伤血管）时，在再手术或皮瓣丢失方面均无差异，但端侧吻合组更常需要静脉移植（p < 0.01）。最后，在 39 例（10.7％）单血管流出的患者中，端端吻合入受伤血管或端侧吻合入未受伤血管在再手术或皮瓣丢失方面均无差异。
皮瓣失败率与下肢通畅血管数量减少相关，但无论哪种类型的微血管吻合术或血管选择均未对重建结果产生影响。
临床问题/证据水平：治疗性，III 级。
