Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany.
Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany.
J Reconstr Microsurg. 2020 Jul;36(6):432-437. doi: 10.1055/s-0040-1702156. Epub 2020 Mar 29.
Whether to perform an end-to-end (ETE) versus end-to-side (ETS) arterial anastomosis is an integral part of preoperative planning and intraoperative decision making in free flap-based reconstructions. This study evaluated the impact of microsurgical anastomotic technique on outcomes of lower extremity reconstructions, with a focus on patients with peripheral arterial disease (PAD).
Over a 6-year period, 425 patients underwent 437 microvascular lower extremity free flap reconstructions with fasciocutaneous anterolateral thigh- or gracilis muscle flaps at a single surgical center. The cases were divided into an ETE ( = 297 patients) versus ETS ( = 128 patients) group according to the anastomotic technique. A retrospective analysis of patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and the potential impact of PAD on outcomes was performed. Patient groups were comparable regarding comorbidities, American Society of Anesthesiologists scores, types of performed free flaps and recipient sites.
We found no significant differences between the ETE versus ETS groups regarding the rate of major or minor complications ( > 0.05). Specifically, in patients suffering from PAD ( = 64) the type of arterial anastomosis had no effect on the outcome.
Overall, no significant differences in outcomes were observed when comparing the types of performed arterial anastomosis. This observation also held true for the subgroup of patients with PAD. Given that an ETS anastomosis did not increase the risk to encounter complications while preserving distal perfusion, we believe that this technique is the method of choice, especially in patients with impaired vascular status.
在游离皮瓣重建中，进行端端吻合（ETE）还是端侧吻合（ETS）是术前规划和术中决策的重要组成部分。本研究评估了显微吻合技术对下肢重建结果的影响，重点关注外周动脉疾病（PAD）患者。
在 6 年期间，在一个单一的外科中心，425 例患者接受了 437 例股前外侧肌或股薄肌筋膜皮瓣游离皮瓣下肢重建术。根据吻合技术将病例分为 ETE（n=297 例）和 ETS（n=128 例）组。对患者的人口统计学、围手术期细节、手术并发症、游离皮瓣类型、受区、皮瓣存活率以及 PAD 对结果的潜在影响进行回顾性分析。患者组在合并症、美国麻醉师协会评分、游离皮瓣类型和受区方面具有可比性。
我们发现 ETE 与 ETS 组在主要或次要并发症的发生率方面没有显著差异（>0.05）。具体来说，在患有 PAD 的患者（n=64）中，动脉吻合的类型对结果没有影响。
总体而言，比较吻合术的类型时，在结果方面没有观察到显著差异。这一观察结果也适用于患有 PAD 的患者亚组。由于 ETS 吻合术在保留远端灌注的同时不会增加并发症的风险，我们认为该技术是首选方法，特别是在血管状况受损的患者中。
