Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan; Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:65-70. doi: 10.1016/j.bjps.2024.07.069. Epub 2024 Aug 3.
Reversed great saphenous vein (GSV) graft is widely used for revascularization in limb-sparing surgery for sarcoma invading great vessels. However, a mismatch in caliber between the reverse graft and cut end of the artery can threaten graft patency. Recently, we introduced the use of a venous valvulotome to allow nonreversed GSV graft. The purpose of this study was to evaluate the safety and versatility of this technique.
We retrospectively compared long-term patency and limb salvage rates between nonreversed GSV and reversed GSV in patients undergoing limb-sparing surgery for sarcoma.
Thirty-seven patients were included, with 21 in the nonreversed GSV group and 16 in the reversed GSV group. Patient characteristics, surgical details, and complications were reviewed from the hospital records. The patency of the reconstructed vessels was assessed using contrast-enhanced CT or MRI. Statistical analyses, including Kaplan-Meier survival analysis, were employed for comparisons.
The median follow-up was 38 months. Overall graft patency was 90.4% (19 of 21 patients) in the nonreversed GSV group and 81.2% (13 of 16) in the reverse GSV (RGSV) group. In the nonreversed GSV group, there was 1 case of graft occlusion each in the acute and chronic phases, but limb circulation remained intact and all limbs were spared.
Nonreversed GSV grafting with valvulotome offers a safe and versatile alternative to reversed GSV grafts in limb-sparing sarcoma surgery. It eliminates the need for vein reversal and minimizes diameter mismatch, potentially expanding the indication for autologous revascularization to previously ineligible cases.
逆行大隐静脉（GSV）移植物广泛应用于侵犯大血管的肉瘤保肢手术中的血运重建。然而，移植物与动脉切断端之间的口径不匹配可能会威胁到移植物的通畅性。最近，我们引入了静脉瓣膜切开刀的使用，以允许非逆行 GSV 移植物的使用。本研究旨在评估该技术的安全性和多功能性。
我们回顾性比较了接受保肢手术治疗肉瘤的患者中非逆行 GSV 和逆行 GSV 的长期通畅率和肢体存活率。
共纳入 37 例患者，其中 21 例为非逆行 GSV 组，16 例为逆行 GSV 组。从病历中回顾患者特征、手术细节和并发症。通过对比增强 CT 或 MRI 评估重建血管的通畅性。采用 Kaplan-Meier 生存分析进行统计学分析。
中位随访时间为 38 个月。非逆行 GSV 组的总体移植物通畅率为 90.4%（21 例中有 19 例），逆行 GSV 组为 81.2%（16 例中有 13 例）。在非逆行 GSV 组中，各有 1 例在急性和慢性阶段发生移植物闭塞，但肢体循环保持完整，所有肢体均得以保留。
在保肢肉瘤手术中，使用瓣膜切开刀的非逆行 GSV 移植为逆行 GSV 移植提供了一种安全且多功能的替代方案。它消除了静脉反转的需要，并最大限度地减少了直径不匹配，可能将自体血运重建的适应证扩展到以前不符合条件的病例。
