Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
Microsurgery. 2021 Sep;41(6):527-532. doi: 10.1002/micr.30718. Epub 2021 Feb 10.
Over the last few years, the increasing employment of perforators as both donor and recipient vessels for free flap tissue transfer lead the surgeons to perform increasingly smaller anastomosis. Size discrepancy is a common problem that might affect the patency rate. This has many implications in the outcome of the procedure and the "Open-Y" technique might be useful to perform an easier anastomosis by using a bifurcation area.
Between April 2018 and April 2020 a total of 98 patients who received a free tissue transfer reconstruction throughout the body were retrospectively recruited. The "Open-Y" technique of anastomosis was used in the recipient artery of 40 perforator-based flaps, while in 58 cases a conventional anastomosis with nonperforator vessel was performed. The size discrepancy rate and the arterial anastomotic site-related complications were evaluated and compared.
The flap success rate was 100% (40/40) in the "Open-Y" group, slightly better than the conventional group (96.5%; 56/58) despite a higher size discrepancy rate in the "Open-Y" group (27.5%; 11/40) compared to the conventional one (12%; 7/58) (p value, .053). The rate of complications was different, too. Better results were obtained in the "Open-Y" group with 4/40 (10%) complications compared to the 18/58 (31%) of the conventional group (p value, .013).
The "Open-Y" technique is a simple and interesting procedure to increase the vessels' diameter thus reducing size discrepancy and increasing the reliability of the anastomosis. This is extremely valuable in the perforator-to-perforator free tissue transfer setting where surgeons are often forced to work in a supermicrosurgical field. Every time a suitable bifurcation is encountered this might be a useful procedure to increase the end-surface available for the anastomosis or to reduce vessels size discrepancy.
在过去的几年中，随着游离皮瓣组织移植中穿支血管被越来越多地用作供体和受体血管，外科医生进行的吻合口越来越小。尺寸不匹配是一个常见的问题，可能会影响吻合口的通畅率。这对手术结果有很多影响，“Open-Y”技术可能通过使用分叉区域来进行更容易的吻合口，从而有用。
在 2018 年 4 月至 2020 年 4 月期间，共回顾性招募了 98 名接受全身游离组织转移重建的患者。在 40 个穿支皮瓣的受体动脉中使用了“Open-Y”吻合技术，而在 58 例中，使用了常规吻合技术与非穿支血管吻合。评估和比较了尺寸不匹配率和动脉吻合部位相关并发症。
在“Open-Y”组中，皮瓣成功率为 100%（40/40），略高于常规组（96.5%；56/58），尽管“Open-Y”组的尺寸不匹配率较高（27.5%；11/40），与常规组（12%；7/58）相比（p 值，.053）。并发症发生率也不同。在“Open-Y”组中，有 4/40（10%）的并发症，而常规组有 18/58（31%）（p 值，.013），结果更好。
“Open-Y”技术是一种简单而有趣的方法，可以增加血管的直径，从而减少尺寸不匹配并提高吻合的可靠性。这在穿支皮瓣游离组织转移中非常有价值，外科医生经常被迫在超微外科领域工作。每次遇到合适的分叉时，这可能是一种有用的方法，可以增加吻合的端面或减少血管尺寸不匹配。
