Department of Plastic Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 40447, Taiwan; Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom.
Department of Plastic Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung 40447, Taiwan.
J Plast Reconstr Aesthet Surg. 2022 Feb;75(2):659-664. doi: 10.1016/j.bjps.2021.09.012. Epub 2021 Oct 8.
Anastomotic vessel size discrepancy may be addressed by numerous techniques, including the end-to-side. Most of these conventional methods are less suited with larger flap vessels relative to recipients, such as the vessel-depleted oncological neck with prior radiotherapy or in supermicrosurgical techniques with perforator recipients. We describe how short segment (single or double) interpositional vein grafts can be used to safely graduate this discrepancy in a 'step-up' or 'step-down' manner.
We conducted a retrospective review of all cases where interpositional vein grafts had been utilised. Furthermore, the technique for harvest, vessel preparation and anastomotic sequence is described.
Over fifteen years, 116 short segment interpositional vein grafts (in 83 patients) were employed to address vessel discrepancy. Concerning patient demographics, there were 81 male:2 female, mean age 51 years (range 27-68 years), and aetiology was oral cancer (75), trauma(7) and congenital(1). Single (50) and double (33) grafts were used for 65 arterial anastomoses (8 step-down: 57 step-up) and 18 for venous anastomoses (12 step-down: 6 step-up). Flaps employed were osteocutaneous fibula (28), anterolateral thigh (24), free ileocolon (11), radial forearm (11), SCIP (7) and others (2). Six flaps (of 83) were lost (5 arterial and 1 venous thrombosis).
Short segment interpositional vein grafts may be safely utilised for 'step-up' and 'step-down' anastomoses. Planned use in the primary case, minimum required length and meticulous preparation are fundamental for success and to dispel traditional concerns over poorer outcomes when vein grafts are used.
吻合口血管大小差异可以通过多种技术来解决，包括端侧吻合。大多数这些传统方法对于相对于受者较大的皮瓣血管不太适用，例如先前接受过放疗的血管耗竭性肿瘤颈部或在带有穿支受者的超显微外科技术中。我们描述了如何使用短段（单或双）间置静脉移植物以“逐步”或“逐步降低”的方式安全地解决这种差异。
我们对所有使用过间置静脉移植物的病例进行了回顾性研究。此外，还描述了采集、血管准备和吻合顺序的技术。
在十五年的时间里，有 83 例患者共使用了 116 个短段间置静脉移植物来解决血管差异问题。就患者人口统计学而言，有 81 例男性：2 例女性，平均年龄 51 岁（范围 27-68 岁），病因是口腔癌（75）、创伤（7）和先天性（1）。使用了单（50）和双（33）移植物进行了 65 次动脉吻合（8 次逐步降低：57 次逐步升高）和 18 次静脉吻合（12 次逐步降低：6 次逐步升高）。使用的皮瓣包括：带骨的腓骨（28）、前外侧股（24）、游离回肠结肠（11）、桡骨前臂（11）、SCIP（7）和其他（2）。有 6 个皮瓣（83 个中的 6 个）丢失（5 个动脉血栓形成和 1 个静脉血栓形成）。
短段间置静脉移植物可安全用于“逐步升高”和“逐步降低”吻合。在初次手术中计划使用、所需最短长度和精心准备是成功的基础，并消除了传统上对使用静脉移植物时效果较差的担忧。
