Hansjörg Wyss Department of Plastic Surgery.
Department of Otolaryngology, NYU Langone Health, New York, NY.
J Craniofac Surg. 2022 May 1;33(3):784-786. doi: 10.1097/SCS.0000000000008288. Epub 2021 Oct 13.
Venous congestion accounts for most microvascular free tissue flaps failures. Given the lack of consensus on the use of single versus dual venous outflow, the authors present our institutional experience with 1 versus 2 vein anastomoses in microvascular free flap for head and neck reconstruction. A retrospective chart review was performed on all patients undergoing free flaps for head and neck reconstruction at our institution between 2008 and 2020. The authors included patients who underwent anterolateral thigh, radial forearm free flap, or fibula free flaps. The authors classified patients based on the number of venous anastomoses used and compared complication rates. A total of 279 patients with a mean age of 55.11 years (standard deviation 19.31) were included. One hundred sixty-eight patients (60.2%) underwent fibula free flaps, 59 (21.1%) anterolateral thigh, and 52 (18.6%) radial forearm free flap. The majority of patients were American Society of Anesthesiologists classification III or higher (N = 158, 56.6%) and had history of radiation (N = 156, 55.9%). Most flaps were performed using a single venous anastomosis (83.8%). Univariate analysis of postoperative outcomes demonstrated no significant differences in overall complications (P = 0.788), flap failure (P = 1.0), return to the Operating Room (OR) (P = 1.0), hematoma (P = 0.225), length of hospital stay (P = 0.725), or venous congestion (P = 0.479). In our cohort, the rate of venous congestion was not statistically different between flaps with 1 and 2 venous anastomoses. Decision to perform a second venous anastomoses should be guided by anatomical location, vessel lie, flap size, and intraoperative visual assessment.
静脉淤血是导致大多数微血管游离组织瓣失败的主要原因。鉴于对于使用单静脉还是双静脉流出道存在缺乏共识，作者介绍了他们在头颈部重建中使用 1 对与 2 对静脉吻合的微血管游离皮瓣的机构经验。对 2008 年至 2020 年期间在他们机构接受游离皮瓣进行头颈部重建的所有患者进行了回顾性图表审查。作者纳入了接受股前外侧皮瓣、桡侧前臂游离皮瓣或腓骨游离皮瓣的患者。作者根据使用的静脉吻合数量对患者进行分类，并比较了并发症发生率。共纳入 279 例患者，平均年龄 55.11 岁（标准差 19.31）。168 例（60.2%）患者行腓骨游离皮瓣，59 例（21.1%）行股前外侧皮瓣，52 例（18.6%）行桡侧前臂游离皮瓣。大多数患者为美国麻醉医师协会（ASA）分级 III 级或以上（N=158，56.6%）和有放疗史（N=156，55.9%）。大多数皮瓣采用单静脉吻合术（83.8%）。术后结果的单因素分析显示，总体并发症（P=0.788）、皮瓣失败（P=1.0）、返回手术室（OR）（P=1.0）、血肿（P=0.225）、住院时间（P=0.725）或静脉淤血（P=0.479）均无显著差异。在他们的队列中，1 对和 2 对静脉吻合的皮瓣静脉淤血发生率无统计学差异。是否进行第二次静脉吻合的决定应根据解剖位置、血管位置、皮瓣大小和术中视觉评估来指导。
