TY - JOUR

T1 - One-Stage versus Two-Stage Arteriovenous Loop Reconstructions

T2 - An Experience on 103 Cases from a Single Center

AU - Henn, Dominic

AU - Wähmann, Matthias S T

AU - Horsch, Miriam

AU - Hetjens, Svetlana

AU - Kremer, Thomas

AU - Gazyakan, Emre

AU - Hirche, Christoph

AU - Schmidt, Volker J

AU - Germann, Günter

AU - Kneser, Ulrich

PY - 2019

Y1 - 2019

N2 - BACKGROUND: The optimal time for flap anastomosis to an arteriovenous loop remains controversial. Whether perforator flaps and axially vascularized muscle or fasciocutaneous flaps lead to comparable outcomes in conjunction with arteriovenous loops has not been investigated.METHODS: Medical records from 103 patients undergoing arteriovenous loop reconstruction (76 one-stage and 27 two-stage) between 2007 and 2017 were reviewed. Postoperative outcomes were compared between one- and two-stage arteriovenous loop reconstructions and different types of free flaps.RESULTS: Rates of flap thrombosis, major wound complications, and flap failure did not differ significantly between one- and two-stage arteriovenous loop reconstructions (14.47 percent versus 11.11 percent, p = 1.00; 30.26 percent versus 25.93 percent, p = 0.67; and 10.53 percent versus 7.41 percent, p = 1.00). For two-stage arteriovenous loop reconstructions, the time interval between arteriovenous loop placement and flap anastomosis was a predictor for thrombotic events (OR, 1.31; p < 0.05). Anterolateral thigh flaps in conjunction with arteriovenous loops showed higher failure rates (33.33 percent) compared with all other flaps (6.59 percent) (p < 0.05) and combined latissimus dorsi and parascapular flaps (0 percent) (p < 0.05). Thrombosis rates were higher in anterolateral thigh flaps (33.33 percent) compared with all other flaps (10.99 percent; p = 0.056), and combined latissimus dorsi and parascapular flaps (0 percent; p < 0.05).CONCLUSIONS: Two-stage arteriovenous loop reconstructions do not lead to increased postoperative complications compared to one-stage arteriovenous loop reconstructions and may be favorable in complicated cases because of shorter operative times. To avoid an increased thrombosis risk, flap anastomosis should not be delayed beyond 10 days in two-stage arteriovenous loop reconstructions. Anterolateral thigh flaps are less suitable for arteriovenous loop reconstructions because of higher complication rates.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

AB - BACKGROUND: The optimal time for flap anastomosis to an arteriovenous loop remains controversial. Whether perforator flaps and axially vascularized muscle or fasciocutaneous flaps lead to comparable outcomes in conjunction with arteriovenous loops has not been investigated.METHODS: Medical records from 103 patients undergoing arteriovenous loop reconstruction (76 one-stage and 27 two-stage) between 2007 and 2017 were reviewed. Postoperative outcomes were compared between one- and two-stage arteriovenous loop reconstructions and different types of free flaps.RESULTS: Rates of flap thrombosis, major wound complications, and flap failure did not differ significantly between one- and two-stage arteriovenous loop reconstructions (14.47 percent versus 11.11 percent, p = 1.00; 30.26 percent versus 25.93 percent, p = 0.67; and 10.53 percent versus 7.41 percent, p = 1.00). For two-stage arteriovenous loop reconstructions, the time interval between arteriovenous loop placement and flap anastomosis was a predictor for thrombotic events (OR, 1.31; p < 0.05). Anterolateral thigh flaps in conjunction with arteriovenous loops showed higher failure rates (33.33 percent) compared with all other flaps (6.59 percent) (p < 0.05) and combined latissimus dorsi and parascapular flaps (0 percent) (p < 0.05). Thrombosis rates were higher in anterolateral thigh flaps (33.33 percent) compared with all other flaps (10.99 percent; p = 0.056), and combined latissimus dorsi and parascapular flaps (0 percent; p < 0.05).CONCLUSIONS: Two-stage arteriovenous loop reconstructions do not lead to increased postoperative complications compared to one-stage arteriovenous loop reconstructions and may be favorable in complicated cases because of shorter operative times. To avoid an increased thrombosis risk, flap anastomosis should not be delayed beyond 10 days in two-stage arteriovenous loop reconstructions. Anterolateral thigh flaps are less suitable for arteriovenous loop reconstructions because of higher complication rates.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anastomosis, Surgical/adverse effects

KW - Child

KW - Female

KW - Free Tissue Flaps/adverse effects

KW - Graft Occlusion, Vascular/epidemiology

KW - Graft Rejection/epidemiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Plastic Surgery Procedures/adverse effects

KW - Retrospective Studies

KW - Thrombosis/epidemiology

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Grafting/adverse effects

KW - Young Adult

U2 - 10.1097/PRS.0000000000005386

DO - 10.1097/PRS.0000000000005386

M3 - Journal article

C2 - 30624338

VL - 143

SP - 912

EP - 924

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 3

ER -