Hamahata Atsumori, Beppu Takeshi, Kirita Miho, Konoeda Hisato, Sakurai Hiroyuki
Division of Plastic and Reconstructive Surgery, Saitama Cancer Center, Saitama, Japan.
Division of Head and Neck Surgery, Saitama Cancer Center, Saitama, Japan.
Plast Reconstr Surg Glob Open. 2023 Jan 25;11(1):e4775. doi: 10.1097/GOX.0000000000004775. eCollection 2023 Jan.
Free tissue transfer has been frequently used in head and neck reconstruction. However, vascular problems still cause serious damage to patients when thromboses occur in microvascular anastomoses. In the Gemini anastomosis procedure, two flap pedicle veins are anastomosed adjacently to the internal jugular vein using the end-to-side anastomosis method. From April 2019 to March 2021, 12 patients whose free flaps had two pedicle veins underwent head and neck surgery in Saitama Cancer Center (Saitama, Japan). In six patients, the veins were anastomosed adjacently to the internal jugular vein using the Gemini procedure (Gemini group). In the other six patients, the veins were anastomosed to the internal jugular vein using the end-to-side anastomosis method at a distance from each other (control group). The anastomosis time was measured retrospectively by reviewing video from the operations and comparing them across groups. There were no reoperations in any patients, and all flaps survived without exhibiting any circulatory problems. The mean total anastomosis time in the Gemini group was 21 minutes 38 seconds ± 75 seconds. The mean total anastomosis time in the control group was 34 minutes 14 seconds ± 121 seconds. The mean flap ischemic time in the Gemini group was 124 minutes ± 3 minutes. The mean flap ischemic time in the control group was 135 minutes ± 6 minutes. The Gemini anastomosis procedure is effective and convenient when the pedicle has two veins and the recipient vein choice is only the internal jugular vein in head and neck reconstruction.
游离组织移植已频繁用于头颈部重建。然而，当微血管吻合处发生血栓形成时，血管问题仍会对患者造成严重损害。在双子吻合手术中，使用端侧吻合方法将两个皮瓣蒂静脉相邻地吻合至颈内静脉。2019年4月至2021年3月，12例游离皮瓣有两条蒂静脉的患者在埼玉癌症中心（日本埼玉）接受了头颈部手术。其中6例患者使用双子手术将静脉相邻地吻合至颈内静脉（双子组）。在其他6例患者中，使用端侧吻合方法将静脉彼此间隔一定距离吻合至颈内静脉（对照组）。通过回顾手术视频并在各小组间进行比较，对吻合时间进行了回顾性测量。所有患者均未进行再次手术，所有皮瓣均存活，未出现任何循环问题。双子组的平均总吻合时间为21分38秒±75秒。对照组的平均总吻合时间为34分14秒±121秒。双子组的平均皮瓣缺血时间为124分钟±3分钟。对照组的平均皮瓣缺血时间为135分钟±6分钟。当头颈部重建中蒂有两条静脉且受区静脉选择仅为颈内静脉时，双子吻合手术有效且便捷。
