Jonas A Nelson1, John P Fischer2, Ritwik Grover3, Stephen J Kovach4, David W Low2, Suhail K Kanchwala2, L Scott Levin4, Joseph M Serletti2, Liza C Wu2. 1. Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jonas.nelson@uphs.upenn.edu. 2. Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA. 4. Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
INTRODUCTION: There is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique. METHODS: All microsurgical cases at a single institution from 2005 to 2011 were examined for use of IVGs in the primary procedure or during take back or salvage attempts. We examined the cohort overall and performed a subgroup analysis by timing of initial IVG. RESULTS: In the study period, 1718 patients underwent 2368 free flaps. 51 IVGs were utilized in 38 patients (2.2%) and 38 flaps (1.6%). Eight (42.1%) of the primary procedure IVGs (n = 19) were planned preoperatively. Nine total flap losses (24%) occurred when IVGs were utilized, 89% of which occurred in the take back cohort (p = 0.02). However, planned IVG had a 100% success rate, and IVG utilized in the primary procedure overall had a 95% success rate. Importantly, A significantly higher rate of thrombotic events was noted in all primary cases where IVGs were utilized (p = 0.005). CONCLUSIONS: This study demonstrates that IVGs can be utilized in primary free flap reconstructions with success rates exceeding 95%. However, in salvage procedures, the use of vein grafts does not approach the same rate of success likely due to multiple factors. Yet when utilized appropriately with thrombectomy and resection of the thrombosed vessel to healthy intima, IVGs can provide an important tool for flap salvage. LEVEL OF EVIDENCE: prognostic/risk category, level II.
INTRODUCTION: There is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique. METHODS: All microsurgical cases at a single institution from 2005 to 2011 were examined for use of IVGs in the primary procedure or during take back or salvage attempts. We examined the cohort overall and performed a subgroup analysis by timing of initial IVG. RESULTS: In the study period, 1718 patients underwent 2368 free flaps. 51 IVGs were utilized in 38 patients (2.2%) and 38 flaps (1.6%). Eight (42.1%) of the primary procedure IVGs (n = 19) were planned preoperatively. Nine total flap losses (24%) occurred when IVGs were utilized, 89% of which occurred in the take back cohort (p = 0.02). However, planned IVG had a 100% success rate, and IVG utilized in the primary procedure overall had a 95% success rate. Importantly, A significantly higher rate of thrombotic events was noted in all primary cases where IVGs were utilized (p = 0.005). CONCLUSIONS: This study demonstrates that IVGs can be utilized in primary free flap reconstructions with success rates exceeding 95%. However, in salvage procedures, the use of vein grafts does not approach the same rate of success likely due to multiple factors. Yet when utilized appropriately with thrombectomy and resection of the thrombosed vessel to healthy intima, IVGs can provide an important tool for flap salvage. LEVEL OF EVIDENCE: prognostic/risk category, level II.
Authors: Michelle Coriddi; Paige Myers; Babak Mehrara; Jonas Nelson; Peter G Cordeiro; Joseph Disa; Evan Matros; Joseph Dayan; Robert Allen; Colleen McCarthy Journal: Microsurgery Date: 2021-12-02 Impact factor: 2.425
Authors: Andreas M Fichter; Thomas Mücke; Lucas M Ritschl; Marie-Kristin Hofmann; Constantin T Wolff; Leonard H Schmidt; Klaus-Dietrich Wolff Journal: Sci Rep Date: 2021-04-22 Impact factor: 4.379
Authors: Paige K Dekker; Salma A Abdou; Richard Youn; Jenna C Bekeny; Kevin G Kim; Elizabeth G Zolper; Kenneth L Fan; Karen K Evans Journal: Plast Reconstr Surg Glob Open Date: 2022-09-23