TY - JOUR

T1 - Venous bypass grafts versus arteriovenous loops as recipient vessels for microvascular anastomosis in lower extremity reconstructions

T2 - A matched-pair analysis

AU - Henn, Dominic

AU - Bigdeli, Amir K

AU - Horsch, Miriam

AU - Weiß, Christel

AU - Kühner, Clemens

AU - Hirche, Christoph

AU - Schmidt, Volker J

AU - Kneser, Ulrich

N1 - © 2019 Wiley Periodicals, Inc.

PY - 2020

Y1 - 2020

N2 - BACKGROUND: Limb salvage in patients with peripheral vascular disease (PVD) and soft tissue defects often requires both a restoration of blood flow to the lower extremity and soft tissue coverage. Outcomes of free tissue transfer may be affected by vein grafts, which can be used for the placement of an autologous venous bypass or an arteriovenous (AV) loop leading to different hemodynamic situations. The purpose of this study was to investigate whether free flap anastomosis to a bypass or an AV loop can be performed with comparable results.METHODS: We performed a matched-pair analysis of 22 patients with PVD undergoing free flap reconstructions of the lower extremity with end-to-side anastomosis to an autologous venous bypass (n = 11, 1 female and 10 male patients) or an AV loop (n = 11, 2 female and 9 male patients). Defects caused by trauma, infection, ulcer, or fasciotomy were reconstructed in each group with 5 muscle-based flaps, 3 parascapular flaps, 2 anterolateral thigh (ALT) flaps, and 1 conjoined latissimus dorsi and parascapular flap. Postoperative complications including thromboses, flap failures, wound complications, and hematomas were compared.RESULTS: Postoperative complication rates including 1 venous pedicle thrombosis (9%vs. 0%, P = 1.0), minor (18% vs. 9%, P = 1.0) and major wound complications (45% vs. 27%, P = .69) as well as hematomas (27% vs. 36%, P = 1.0) did not show relevant differences between the groups. Flap failures were absent in both groups.CONCLUSION: In patients with PVD, autologous venous bypass grafts may be used for end-to-side anastomoses of free flaps, with postoperative outcomes being comparable to AV loop reconstructions.

AB - BACKGROUND: Limb salvage in patients with peripheral vascular disease (PVD) and soft tissue defects often requires both a restoration of blood flow to the lower extremity and soft tissue coverage. Outcomes of free tissue transfer may be affected by vein grafts, which can be used for the placement of an autologous venous bypass or an arteriovenous (AV) loop leading to different hemodynamic situations. The purpose of this study was to investigate whether free flap anastomosis to a bypass or an AV loop can be performed with comparable results.METHODS: We performed a matched-pair analysis of 22 patients with PVD undergoing free flap reconstructions of the lower extremity with end-to-side anastomosis to an autologous venous bypass (n = 11, 1 female and 10 male patients) or an AV loop (n = 11, 2 female and 9 male patients). Defects caused by trauma, infection, ulcer, or fasciotomy were reconstructed in each group with 5 muscle-based flaps, 3 parascapular flaps, 2 anterolateral thigh (ALT) flaps, and 1 conjoined latissimus dorsi and parascapular flap. Postoperative complications including thromboses, flap failures, wound complications, and hematomas were compared.RESULTS: Postoperative complication rates including 1 venous pedicle thrombosis (9%vs. 0%, P = 1.0), minor (18% vs. 9%, P = 1.0) and major wound complications (45% vs. 27%, P = .69) as well as hematomas (27% vs. 36%, P = 1.0) did not show relevant differences between the groups. Flap failures were absent in both groups.CONCLUSION: In patients with PVD, autologous venous bypass grafts may be used for end-to-side anastomoses of free flaps, with postoperative outcomes being comparable to AV loop reconstructions.

KW - Aged

KW - Anastomosis, Surgical

KW - Female

KW - Free Tissue Flaps

KW - Humans

KW - Limb Salvage

KW - Male

KW - Matched-Pair Analysis

KW - Microsurgery

KW - Middle Aged

KW - Operative Time

KW - Peripheral Arterial Disease/surgery

KW - Postoperative Complications/epidemiology

KW - Plastic Surgery Procedures

KW - Soft Tissue Injuries/surgery

KW - Treatment Outcome

KW - Vascular Surgical Procedures

U2 - 10.1002/micr.30428

DO - 10.1002/micr.30428

M3 - Journal article

C2 - 30677162

VL - 40

SP - 12

EP - 18

JO - International Journal of Microsurgery

JF - International Journal of Microsurgery

SN - 0738-1085

IS - 1

ER -