Boissiere Florian, Gandolfi Silvia, Riot Samuel, Kerfant Nathalie, Jenzeri Abdesselem, Hendriks Sarah, Grolleau Jean-Louis, Khechimi Myriam, Herlin Christian, Chaput Benoit
Department of Plastic, Reconstructive and Aesthetic Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France.
Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France.
Plast Reconstr Surg Glob Open. 2021 Jan 22;9(1):e3327. doi: 10.1097/GOX.0000000000003327. eCollection 2021 Jan.
Venous congestion is a frequent problem in flap surgery. Other than surgical revision, there are a multitude of procedures in the literature to tackle this problem, but their effectiveness is not clear. Through a systematic review, we aimed to identify and evaluate the different interventions available for managing flap venous congestion.
The MEDLINE, PubMed central, Embase, and Cochrane databases were searched. The study selection process was adapted from the PRISMA statement. All English and French original articles describing or comparing a method for managing flap venous congestion were included. For each article, a level of evidence was assigned, as defined by the Oxford Centre for Evidence-based Medicine. Lastly, we specifically analyzed the effectiveness of postoperative non-surgical methods. No formal analysis was performed.
Through literature searches carried out in various databases, we identified 224 articles. Finally, 72 articles were included. The majority of these studies had a low-level evidence. A total of 17 different methods (7 pre- and intraoperative, and 10 postoperative) were found. Concerning non-surgical methods, the most represented were leeches, local subcutaneous injection of heparin with scarification, venocutaneous catheterization, negative pressure therapy, and hyperbaric oxygen therapy.
Risks of venous congestion of flaps must always be present in a surgeon's mind, at every stage of flap surgery. Apart from studies on the use of leeches, which have a significant follow-up and large enough patient numbers to support their efficacy, the low-level evidence associated with studies of other methods of venous congestion management does not allow us to draw a scientifically valid conclusion about their effectiveness.
静脉淤血是皮瓣手术中常见的问题。除了手术修复外，文献中有多种处理该问题的方法，但其有效性尚不清楚。通过系统综述，我们旨在识别和评估可用于处理皮瓣静脉淤血的不同干预措施。
检索了MEDLINE、PubMed中心、Embase和Cochrane数据库。研究选择过程采用PRISMA声明。纳入所有描述或比较皮瓣静脉淤血管理方法的英文和法文原创文章。根据牛津循证医学中心的定义，为每篇文章确定证据水平。最后，我们专门分析了术后非手术方法的有效性。未进行正式分析。
通过在多个数据库中进行文献检索，我们识别出224篇文章。最终纳入72篇文章。这些研究大多证据水平较低。共发现17种不同方法（7种术前和术中方法，10种术后方法）。关于非手术方法，最具代表性的是水蛭疗法、局部皮下注射肝素并划痕、静脉皮肤导管插入术、负压疗法和高压氧疗法。
在皮瓣手术的每个阶段，外科医生都必须始终牢记皮瓣静脉淤血的风险。除了关于水蛭疗法的研究有大量随访且患者数量足以支持其疗效外，其他静脉淤血管理方法研究的低证据水平使我们无法就其有效性得出科学有效的结论。
