Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, Alberta, Canada.
Microsurgery. 2021 Nov;41(8):792-801. doi: 10.1002/micr.30811. Epub 2021 Sep 27.
Microsurgical free tissue transfers are a mainstay of lower extremity reconstruction. Despite being a reliable source of soft tissue, complications do arise. Venous congestion is among the most common causes of flap failure in lower extremity reconstruction, an issue that is attributed to venous stasis and impaired venous return in this region. There remains significant debate whether dual venous drainage improves outcomes. The aim of this study was thus to compare one versus two venous anastomoses in lower limb free flap reconstruction.
A systematic review of Medline, EMBASE, EBSCO CINAHL, SCOPUS, Proquest Dissertations and Theses Global, Cochrane Library, and PROSPERO from inception to May 20, 2020, was conducted. Two independent reviewers screened titles and extracted data. Our primary outcome was total free flap necrosis. Secondary outcomes were partial flap necrosis, minor complications, flap reoperation, venous thrombosis, and amputation. Methodological quality was assessed using the MINORS criteria and level of evidence.
Three-hundred and fourteen unique titles were identified. All studies were level VI evidence and had a mean MINORS score of 16.1/24. Seven studies (comprising 1499 patients, 910 single venous anastomoses, and 579 double venous anastomoses) met criteria for inclusion. The mean (SD) patient age was 46.5 (7.1) years. Double venous anastomoses did not reduce the rate of minor complications, flap takeback, venous thrombosis, total flap necrosis, or partial flap necrosis when compared to a single vein (all p > .05).
In microvascular lower extremity reconstruction, two venous anastomoses did not reduce the rate of minor or major complications.
显微游离组织移植是下肢重建的主要方法。尽管是软组织的可靠来源，但也会出现并发症。静脉淤血是下肢重建中皮瓣失败的最常见原因之一，这一问题归因于该区域的静脉淤滞和静脉回流受损。对于双静脉引流是否能改善结果仍存在很大争议。因此，本研究旨在比较下肢游离皮瓣重建中采用单静脉吻合与双静脉吻合的效果。
对 Medline、EMBASE、EBSCO CINAHL、SCOPUS、Proquest Dissertations and Theses Global、Cochrane Library 和 PROSPERO 从建库至 2020 年 5 月 20 日进行了系统回顾。两名独立审查员筛选标题并提取数据。我们的主要结局指标是游离皮瓣总坏死。次要结局指标包括部分皮瓣坏死、轻微并发症、皮瓣再手术、静脉血栓形成和截肢。使用 MINORS 标准和证据水平评估方法学质量。
共确定了 314 个独特的标题。所有研究均为 VI 级证据，MINORS 评分平均为 16.1/24。有 7 项研究（共 1499 例患者，910 例单静脉吻合，579 例双静脉吻合）符合纳入标准。患者平均（SD）年龄为 46.5（7.1）岁。与单静脉吻合相比，双静脉吻合并不能降低轻微并发症、皮瓣回收、静脉血栓形成、总皮瓣坏死或部分皮瓣坏死的发生率（均 P＞.05）。
在下肢显微血管重建中，双静脉吻合并不能降低轻微或严重并发症的发生率。
