Abstract
Background Many microsurgeons fear high complication rates and free flap loss when vein grafting
is necessary to restore blood flow at the recipient site. The aims of this study were
to comparatively analyze surgical outcomes of interposition vein grafts (VG) in microsurgical
primary lower extremity reconstruction and secondary salvage procedures.
Methods A retrospective study was conducted on 58 patients undergoing free flap transfers
with vein grafting for primary lower extremity reconstruction (cohort 1) and secondary
salvage procedures (cohort 2) between 2002 and 2016. A matched-pair analysis of both
cohorts and 58 non-VG flaps was performed. Patient data, preoperative conditions,
flap and vein graft characteristics, postoperative outcomes such as flap failure,
thrombosis, and wound complications were analyzed.
Results A total of 726 free flap transfers were performed. In total, 36 primary reconstructions
(5%) utilized 41 interposition VG (cohort 1). Postoperative vascular compromise was
observed in 65 free flaps (9%). In total, 22 out of 65 secondary salvage procedures
(33.8%) utilized 26 interposition VG (cohort 2). Two total flap losses occurred in
each cohort (5.6 vs. 9.1%; p = 0.63). Postoperative complications were observed in 38.9% of free flaps in cohort
1 and 72.7% in cohort 2 (p = 0.01). Takeback for microvascular compromise was comparable in both cohorts (19.4
vs. 22.7%; p = 0.75). Microvascular complications occurred more often in cohort 2 (22.7%) than
in cohort 1 (8.3%; p = 0.28). Lower extremity salvage rates were high among both cohorts (94.4 vs. 90.9%;
p = 0.63). Matched-pair analysis did not show any relevant differences on takebacks
and flap loss (p = 0.32 and p = 1.0).
Conclusion In complex lower extremity reconstructions, VG can be performed with acceptable complication
rates and outcomes in primary and especially in salvage cases. With careful planning
and a consistent surgical protocol, VG can provide reliable success rates in limb
salvage.
Keywords
vein graft - interposition vein grafting - free flap reconstruction - lower extremity
reconstruction
