One versus Two Venous Anastomoses in Microvascular Upper Extremity Reconstruction

Denis Ehrl; Paul I. Heidekrueger; Albrecht Heine-Geldern; Milomir Ninkovic; P. Niclas Broer

doi:10.1055/s-0037-1602759

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2017; 33(07): 502-508
DOI: 10.1055/s-0037-1602759

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

One versus Two Venous Anastomoses in Microvascular Upper Extremity Reconstruction

Denis Ehrl

¹Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany

^*Both the authors have contributed equally to this article.

,

Paul I. Heidekrueger

¹Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany

^*Both the authors have contributed equally to this article.

,

Albrecht Heine-Geldern

¹Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany

,

Milomir Ninkovic

¹Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany

,

P. Niclas Broer

¹Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany

› Author Affiliations

Abstract

Background Free tissue transfers are routinely performed for reconstruction of the upper limb. Main complication in free flap surgery still stems from vascular compromise and many technical controversies exist regarding the technical details of how to perform the microvascular anastomosis. This study evaluates outcomes regarding the execution of one versus two venous anastomoses for upper limb reconstruction.

Methods In this study, 79 patients underwent 86 free anterolateral thigh (ALT) or groin flaps for upper limb reconstruction after trauma, infection, or malignancies. The data were retrospectively screened for patients' demographics, perioperative details, flap survival, and surgical complications. The cases were divided into two groups regarding the number of performed venous anastomoses: one versus two veins.

Results No significant differences existed between the two groups regarding preoperative comorbidities (ALT: 16 one, 21 two veins; groin: 16 one, 33 two veins). Overall, there was no significant difference regarding the rate of major (1 vein: 18.8% vs. 2 veins: 20.4%; p > 0.05) and minor (1 vein: 3.1% vs. 2 veins: 3.7%; p > 0.05) surgical complications during the 3-month follow-up period. Major complications included total flap losses of 9.4% (1 vein) versus 7.4% (2 veins) (p > 0.05).

Conclusion This study analyzed a series of microsurgical reconstructions with a focus on the impact of the number of performed venous anastomoses. The findings suggest that successful free tissue transfer for upper limb reconstruction can be achieved independent of the number of venous anastomoses. However, to promote additional safety, a second vein should be performed whenever technically possible.

Keywords

upper limb reconstruction - free flap surgery - venous anastomosis

Full Text

References

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