Motomiya Makoto, Watanabe Naoya, Nakamura Shunichi, Kameda Yusuke, Kawamura Daisuke, Iwasaki Norimasa
Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Obihiro, JAPAN.
Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Obihiro, JAPAN.
J Plast Reconstr Aesthet Surg. 2021 Oct;74(10):2495-2503. doi: 10.1016/j.bjps.2021.03.022. Epub 2021 Mar 28.
Although many studies have investigated the optimal anastomotic procedure for the end-to-side (ETS) procedure with a free flap, no study has focused on the size of the arteriotomy. Some surgeons have recently described the effectiveness of ETS with wide arteriotomy, but the postoperative haemodynamics remains unclear for free flaps created using this technique. The aim of this study was to use ultrasonography to evaluate the postoperative blood flow distribution after ETS with a wide arteriotomy in extremity free flap surgery.
We evaluated 20 free flaps in 18 consecutive patients who received an ultrasonographic examination after free flap surgery using the ETS technique with wide arteriotomy for arterial anastomosis. All flaps were examined after surgery and blood flow was calculated for the flap and recipient vessels.
All 20 flaps survived, but one flap developed asymptomatic arterial thrombosis and 19 flaps were analysed. For the ETS technique with wide arteriotomy, peripheral circulation was well preserved in all flaps. Comparison of flap types showed that blood flow was significantly higher in myocutaneous flaps than in fasciocutaneous flaps, but there was no significant difference according to the size of the arteriotomy.
Given the range of arteriotomy performed using the ETS with a wide arteriotomy technique, the blood flow volume in the flap depended on the type of flap but not on the size of the arteriotomy. A steal phenomenon related to the creation of a wide window in the receipt artery was not found in the analysed retrospective cohort.
尽管许多研究探讨了游离皮瓣端侧吻合术（ETS）的最佳吻合方法，但尚无研究关注动脉切开的大小。最近一些外科医生描述了宽动脉切开的ETS的有效性，但对于使用该技术创建的游离皮瓣，术后血流动力学仍不清楚。本研究的目的是使用超声评估肢体游离皮瓣手术中宽动脉切开的ETS术后的血流分布。
我们评估了18例连续患者的20个游离皮瓣，这些患者在游离皮瓣手术后接受了超声检查，采用宽动脉切开的ETS技术进行动脉吻合。所有皮瓣术后均进行检查，并计算皮瓣和受区血管的血流量。
20个皮瓣全部存活，但1个皮瓣出现无症状性动脉血栓形成，对19个皮瓣进行了分析。对于宽动脉切开的ETS技术，所有皮瓣的外周循环均得到良好保留。皮瓣类型比较显示，肌皮瓣的血流量显著高于筋膜皮瓣，但根据动脉切开的大小无显著差异。
鉴于采用宽动脉切开的ETS技术所进行的动脉切开范围，皮瓣中的血流量取决于皮瓣类型而非动脉切开的大小。在分析的回顾性队列中未发现与在受区动脉中创建宽窗口相关的盗血现象。
