Department of Plastic and Reconstructive Surgery, Ramaiah Medical College, Bangalore, Karnataka, India.
Department of plastic surgery, Ramaiah Medical College, Bangalore, Karnataka, India.
Microsurgery. 2023 Jul;43(5):490-495. doi: 10.1002/micr.31055. Epub 2023 Jun 22.
During the free flap surgery obtaining a suitable recipient vein is an important factor for successful outcome. As in all other flaps even in ALT flap, single or double venous anastomosis, superficial or deep venous anastomosis is still a matter of debate among the micro vascular surgeons. Though dual vein anastomosis is a time-tested method, single vein anastomosis has the advantage of reducing the operative time and hospitalization cost. Similarly, in situation where the deep veins are dubious superficial veins are savior. This study explores the outcome of ALT flap using different system of recipient veins.
Retrospective analysis of the 54 free ALT flaps performed over a period of 5 years from June 2017 till June 2022, was carried out. Out of 54, 38 (63%) were male patients and 16 (37%) were females. The outcome of the flaps was evaluated in single or dual anastomosis group. Similarly, the outcome of the flaps with deep or superficial vein anastomosis was also evaluated. The flaps outcomes are evaluated as favorable (successful as well as partial loss are considered as favorable) and unfavorable (complete loss of the flap).
Among the 54 flaps, 31 patients had lower limb reconstruction, majority were post-traumatic defects. Twenty patients had head and neck reconstruction following post malignancy excision. Three patients had upper-limb reconstruction for post traumatic and burn injury defects. The outcome was analyzed. Twenty patients had dual vein anastomosis, 90% (18 out of 20) of patients had favorable outcome and 10% (2 out of 20) had unfavorable outcome. Thirty-four patients underwent single vein anastomosis, 94% had favorable outcome and 6% had unfavorable outcome. The result was not statistically significant as p < .05. Seven patients underwent superficial vein recipient anastomosis, and all flaps were (100%) successful and no failure, whereas out of 27 patients who had undergone deep vein anastomosis 25 (92%) had favorable outcome and 2 (8%) had unfavorable outcome. The results were not statistically significant as p > .05.
As in other free flaps venous anastomosis compromise is the cause for flap failure in majority of the times. Whenever possible, dual vein anastomosis should be considered. But when impervious, single vein anastomosis can be resorted to without any hesitation. Similarly, unavailability of deep veins should not deter the surgeons. Superficial veins were a savior in such situation and can be advantageous too.
在游离皮瓣手术中，获得合适的受区静脉是手术成功的重要因素。与所有其他皮瓣一样，即使是 ALT 皮瓣，也存在单静脉吻合或双静脉吻合、浅静脉吻合或深静脉吻合的争议，这些都是显微血管外科医生关注的问题。虽然双静脉吻合是一种经过时间考验的方法，但单静脉吻合具有减少手术时间和住院费用的优势。同样，在深静脉不可靠的情况下，浅静脉是救星。本研究探讨了不同受区静脉系统对 ALT 皮瓣的影响。
对 2017 年 6 月至 2022 年 6 月期间进行的 54 例游离 ALT 皮瓣进行回顾性分析。54 例中，男性 38 例（63%），女性 16 例（37%）。在单吻合组或双吻合组中评估皮瓣的结果。同样，评估深静脉或浅静脉吻合的皮瓣结果。皮瓣结果评估为良好（成功和部分丧失均被认为是良好的）和不良（皮瓣完全丧失）。
在 54 例皮瓣中，31 例患者进行下肢重建，多数为创伤后缺损。20 例患者因恶性肿瘤切除后进行头颈部重建。3 例患者因创伤和烧伤后缺损进行上肢重建。对结果进行了分析。20 例患者进行了双静脉吻合，90%（18/20）的患者有良好的结果，10%（2/20）的患者有不良的结果。34 例患者进行了单静脉吻合，94%有良好的结果，6%有不良的结果。结果无统计学意义（p<0.05）。7 例患者进行了浅静脉受区吻合，所有皮瓣均（100%）成功，无一例失败，而在 27 例进行深静脉吻合的患者中，25 例（92%）有良好的结果，2 例（8%）有不良的结果。结果无统计学意义（p>0.05）。
与其他游离皮瓣一样，静脉吻合不良是大多数皮瓣失败的原因。只要有可能，就应考虑双静脉吻合。但是，当不可能时，可以毫不犹豫地采用单静脉吻合。同样，深静脉的缺失不应阻止外科医生。在这种情况下，浅静脉是救星，也有优势。
