Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Reconstr Microsurg. 2021 Sep;37(7):608-616. doi: 10.1055/s-0041-1723823. Epub 2021 Feb 16.
Many microsurgeons fear high complication rates and free flap loss when vein grafting is necessary to restore blood flow at the recipient site. The aims of this study were to comparatively analyze surgical outcomes of interposition vein grafts (VG) in microsurgical primary lower extremity reconstruction and secondary salvage procedures.
A retrospective study was conducted on 58 patients undergoing free flap transfers with vein grafting for primary lower extremity reconstruction (cohort 1) and secondary salvage procedures (cohort 2) between 2002 and 2016. A matched-pair analysis of both cohorts and 58 non-VG flaps was performed. Patient data, preoperative conditions, flap and vein graft characteristics, postoperative outcomes such as flap failure, thrombosis, and wound complications were analyzed.
A total of 726 free flap transfers were performed. In total, 36 primary reconstructions (5%) utilized 41 interposition VG (cohort 1). Postoperative vascular compromise was observed in 65 free flaps (9%). In total, 22 out of 65 secondary salvage procedures (33.8%) utilized 26 interposition VG (cohort 2). Two total flap losses occurred in each cohort (5.6 vs. 9.1%; = 0.63). Postoperative complications were observed in 38.9% of free flaps in cohort 1 and 72.7% in cohort 2 ( = 0.01). Takeback for microvascular compromise was comparable in both cohorts (19.4 vs. 22.7%; = 0.75). Microvascular complications occurred more often in cohort 2 (22.7%) than in cohort 1 (8.3%; = 0.28). Lower extremity salvage rates were high among both cohorts (94.4 vs. 90.9%; = 0.63). Matched-pair analysis did not show any relevant differences on takebacks and flap loss ( = 0.32 and = 1.0).
In complex lower extremity reconstructions, VG can be performed with acceptable complication rates and outcomes in primary and especially in salvage cases. With careful planning and a consistent surgical protocol, VG can provide reliable success rates in limb salvage.
许多显微外科医生在需要静脉移植来恢复受区血流时，担心会出现高并发症率和游离皮瓣丢失。本研究旨在比较分析静脉移植（VG）在显微外科下肢原发性重建和继发性挽救性手术中的手术结果。
对 2002 年至 2016 年间进行游离皮瓣移植并进行静脉移植的 58 例原发性下肢重建（队列 1）和继发性挽救性手术（队列 2）患者进行回顾性研究。对两组患者和 58 例非 VG 皮瓣进行配对分析。分析患者资料、术前情况、皮瓣和静脉移植物特征、术后并发症如皮瓣失败、血栓形成和伤口并发症等。
共进行了 726 次游离皮瓣移植。共有 36 例原发性重建（5%）采用 41 个静脉间置 VG（队列 1）。65 个游离皮瓣术后出现血管功能障碍（9%）。共有 22 个静脉间置 VG（队列 2）用于 22 个继发性挽救性手术（33.8%）。两个队列均发生 2 例皮瓣完全丢失（5.6%比 9.1%；=0.63）。队列 1 中 38.9%的游离皮瓣出现术后并发症，队列 2 中 72.7%的游离皮瓣出现术后并发症（=0.01）。两组血管再吻合的比例相似（19.4%比 22.7%；=0.75）。队列 2 的微血管并发症发生率（22.7%）高于队列 1（8.3%；=0.28）。两组下肢挽救率均较高（94.4%比 90.9%；=0.63）。配对分析显示血管再吻合和皮瓣丢失的差异均无统计学意义（=0.32 和 = 1.0）。
在复杂的下肢重建中，静脉移植可以在原发性和特别是挽救性病例中以可接受的并发症发生率和结果进行。通过精心的规划和一致的手术方案，静脉移植可以为肢体挽救提供可靠的成功率。
