From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Plast Surg. 2022 Oct 1;89(4):412-418. doi: 10.1097/SAP.0000000000003257. Epub 2022 Jun 11.
The paucity of reliable recipient vessels adjacent to defects poses a great challenge in free flap reconstruction. Although the use of interposition vein grafts to cover the vascular gap is common, its potential association with higher risks of flap compromise is often reported. Interposition arteriovenous bundle grafts have been introduced as an alternative. This study aimed to evaluate the outcomes of free tissue transfer using interposition arteriovenous bundle grafts and to conduct a systematic review of studies that reported the use of the technique.
Patients who underwent free tissue transfer using the interposition arteriovenous bundle graft technique were assessed for flap perfusion-related complications. A systematic review of literature was performed using pooled analysis to calculate the rate of perfusion-related complications.
Overall, 14 cases of free flap reconstruction used the interposition arteriovenous bundle graft technique to cover vascular gaps in diverse regions. The most common donor vessel of this graft was the descending branch of the lateral circumflex femoral vessels (mean length, 6.9 cm). All flaps survived except for 1 case of partial flap loss, showing a flap compromise rate of 7.1%. A systematic review identified 13 studies that represented 78 cases using this technique. In the pooled analysis, including the current series, the overall flap survival rate was 95.7%, reporting 4 of 92 cases of flap compromise.
The interposition arteriovenous bundle graft technique may help overcome the challenges of pedicle shortage or lack of adjacent recipient vessels in free flap reconstruction.
毗邻缺损部位的可靠受区血管稀少，这给游离皮瓣重建带来了巨大挑战。虽然使用静脉移植物来覆盖血管间隙是常见的，但它通常与更高的皮瓣风险相关联。因此，有人提出了使用血管束间置移植的方法。本研究旨在评估使用血管束间置移植进行游离组织转移的结果，并对报道该技术的研究进行系统回顾。
评估了使用血管束间置移植技术进行游离组织转移的患者与皮瓣灌注相关并发症。通过汇总分析进行了文献系统回顾，以计算灌注相关并发症的发生率。
总体而言，14 例游离皮瓣重建使用了血管束间置移植技术来覆盖不同部位的血管间隙。该移植的最常见供体血管是旋股外侧动脉降支（平均长度为 6.9cm）。除 1 例部分皮瓣坏死外，所有皮瓣均存活，皮瓣失效率为 7.1%。系统回顾确定了 13 项使用该技术的研究，共代表了 78 例病例。在包括当前系列的汇总分析中，总皮瓣存活率为 95.7%，报告了 92 例皮瓣失效率中的 4 例。
血管束间置移植技术可帮助克服游离皮瓣重建中蒂部短缺或缺乏毗邻受区血管的挑战。
