Division of Orthopeadic Surgery, Orthopaedic Surgery, Duson Hospital, Ansan City, Republic of Korea.
Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Microsurgery. 2024 Jan;44(1):e31084. doi: 10.1002/micr.31084. Epub 2023 Jul 10.
Reverse-flow flaps rely on retrograde or reverse flow for drainage and have shown success in reconstructive surgery. However, limited studies have been conducted on the use of reverse-flow recipient veins. Our study proposed bidirectional venous anastomoses within a single recipient vein to optimize venous outflow and evaluated the outcomes of an additional retrograde venous anastomosis group in traumatic extremity reconstruction.
We performed a retrospective analysis of 188 patients with traumatic extremity free flap using two venous anastomoses, which were divided into the antegrade and bidirectional venous anastomosis groups. We analyzed the basic demographic information, flap type, duration between injury and reconstruction, recipient vessels, postoperative flap outcomes, and complications. Propensity score matching was used for the additional analysis.
Of the 188 patients analyzed, 63 free flaps (126 anastomoses, 33.5%) and 125 free flaps (250 anastomoses, 66.5%) were included in the bidirectional venous anastomosis and antegrade groups, respectively. In the bidirectional vein group, the median time between trauma and reconstruction was 13.0 ± 1.8 days and the mean flap area was 50.29 ± 7.38 cm . Radial artery superficial palmar branch perforator flap was most frequently performed (60.3%). In the antegrade vein group, the median time until surgery was 23.0 ± 2.1 days and the mean flap area was 85.0 ± 8.5 cm . Thoracodorsal artery perforator flap surgery was the most frequently performed surgery. The two groups were similar in terms of basic characteristics, but the bidirectional group demonstrated significantly higher success rate (98.4% vs. 89.7%, p = .004) and lower complication rate (6.3% vs. 22.4%, p = .007) than the antegrade group. However, these results were not observed after propensity score matching.
Our study demonstrated successful results with the recipient vein using reverse flow. Additional retrograde venous anastomosis is a useful option for augmenting venous drainage for reconstruction of distal extremities in cases where dissection of additional antegrade vein is not feasible.
逆行皮瓣依靠逆行或反向血流进行引流，并已在重建手术中取得成功。然而，对于逆行受体静脉的应用，研究有限。我们的研究提出在单个受体静脉内进行双向静脉吻合，以优化静脉流出，并评估在创伤性四肢重建中额外逆行静脉吻合组的结果。
我们对 188 例使用双静脉吻合的创伤性肢体游离皮瓣患者进行回顾性分析，将其分为顺行和双向静脉吻合组。我们分析了基本人口统计学信息、皮瓣类型、损伤与重建之间的时间、受体血管、术后皮瓣结果和并发症。采用倾向评分匹配进行附加分析。
在分析的 188 例患者中，63 例游离皮瓣（126 个吻合口，33.5%）和 125 例游离皮瓣（250 个吻合口，66.5%）分别纳入双向静脉吻合和顺行静脉吻合组。在双向静脉组中，创伤与重建之间的中位时间为 13.0±1.8 天，平均皮瓣面积为 50.29±7.38cm。桡动脉掌浅支穿支皮瓣最为常见（60.3%）。在顺行静脉组中，手术至手术的中位时间为 23.0±2.1 天，平均皮瓣面积为 85.0±8.5cm。胸背动脉穿支皮瓣手术最为常见。两组基本特征相似，但双向组的成功率（98.4%比 89.7%，p=0.004）和并发症发生率（6.3%比 22.4%，p=0.007）明显高于顺行组。然而，这些结果在倾向评分匹配后并未观察到。
本研究显示，使用逆行血流的受体静脉具有良好的效果。在无法解剖额外顺行静脉的情况下，额外逆行静脉吻合是增加远端肢体重建静脉引流的有效选择。
