A retrospective study of end-to-side venous anastomosis for free flap in extremity reconstruction

Mao, Haijun; Xu, Guangyue

doi:10.1016/j.ijsu.2015.03.016

Cited by 11 publications

(12 citation statements)

References 25 publications

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“…(c) Three-week postoperative follow-up view of the left popliteal fossa defect that was repaired with a free latissimus dorsi flap after radical resection of recurrent myxofibrosarcoma (Miyamoto et al, 2020). Other determinants of successful end-to-side anastomoses include surgical technique, surgical site, and flap and recipient vessel selection (Ashjian et al, 2007;Mao & Xu, 2015). As demonstrated, these factors that compromised the popliteal artery in our case were remedied with a bovine pericardial patch repair.…”

Section: Discussionmentioning

confidence: 75%

“…Neoadjuvant radiation followed by reconstruction of the irradiated field can lead to vessel size discrepancy, which alone, is a major risk factor of vessel thrombosis and flap failure (Miyamoto et al, 2020 ). Other determinants of successful end‐to‐side anastomoses include surgical technique, surgical site, and flap and recipient vessel selection (Ashjian et al, 2007 ; Mao & Xu, 2015 ). As demonstrated, these factors that compromised the popliteal artery in our case were remedied with a bovine pericardial patch repair.…”

Section: Discussionmentioning

confidence: 99%

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Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report

et al. 2022

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Soft tissue sarcomas treated by extensive surgical resection and adjuvant radiation can lead to large tissue deficits that require free flap repair. Significant radiation can further compromise vessels necessitating novel therapeutic approaches. We describe an 82‐year‐old man who presented with a posterior thigh sarcoma and underwent wide local tumor resection and immediate reconstruction with a microvascular free flap. Due to radiated recipient vessels, this case required bovine patch angioplasty as a conduit for end to side anastomosis. Initial resection and pathology revealed a large myxofibrosarcoma. Wide local resection and radiotherapy resulted in a large irradiated soft tissue defect of 26 x 15 x 4 cm with exposed, radiation damaged neurovascular structures, and a lack of available regional flap options. The planned free flap, a 30 x 8 cm skin island from the left latissimus dorsi muscle with end‐to‐side anastomosis to the popliteal artery was complicated by friability of the vessel wall and insufficient perfusion. Given the extent of resection and radiation, there were no alternative recipient vessels present within the field. A bovine pericardial patch angioplasty of 2.5 cm in length was performed to the diseased popliteal vessel and an end to side anastomosis was successfully performed between the thoracodorsal artery and the patch. Improved reperfusion of the free flap was noted immediately following anastomosis indicating completion of the anastomosis of our complicated recipient vessel. During the uncomplicated postoperative course, the flap had good perfusion with Doppler signals present, and incision sites intact at discharge from acute hospitalization. Recurrent sarcomas that have undergone extensive resection and radiotherapy pose significant reconstructive challenges. For defects that require free tissue reconstruction when there are limited options for healthy, recipient vessels, bovine pericardial patch angioplasty may act as a robust conduit for diseased vessels.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report

et al. 2022

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“…Notably, the ETS anastomosis group had a lower proportion of cases within 7-90 days from injury to coverage than ETE anastomosis groups, suggesting that ETS anastomosis groups were selected in comparatively advantageous conditions. Although ETS venous anastomoses have been mainly reported in the head and neck region [13], there have been several successful reports in the lower extremity [5,6]. In addition, flow-through venous anastomosis has also been shown to have a lower rate of microvascular complications than ETE anastomosis in oncologic lower extremity reconstruction [14].…”

Section: Venous Anastomosismentioning

confidence: 99%

“…Venous size mismatch was shown to be a high-risk factor in flap complications in end-to-end (ETE) venous anastomoses during lower extremity reconstruction [2,3], and the deep venous system has been more reliable as a recipient site for outflow compared with the superficial venous system [4]. Furthermore, end-toside (ETS) venous anastomoses have been shown to be safe with a low rate of microvascular complications in lower extremity reconstructions [5,6]. However, there is some controversy over whether one-or two-vein anastomoses offer optimal venous outflow in these reconstructions [3,4,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap

Shimbo¹,

Shinomiya²,

Sunagawa³

et al. 2022

Cureus

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BackgroundVenous thrombosis has been shown to be the most frequent cause of free flap failure in traumatic lower extremity injuries. However, the roles of various anastomotic venous factors, including venous anastomosis (end-to-end (ETE) or end-to-side (ETS)), venous outflow (one vein or two veins), and recipient venous selection (deep or superficial vein), remain unclear. This retrospective study aims to investigate factors contributing to microvascular complications in patients with lower extremity Gustilo type IIIB/IIIC injuries reconstructed by free flap with a focus on the three abovementioned venous factors. MethodsA total of 44 flap treatment outcomes of 41 patients with these injuries from 2015 to 2020 were assessed according to the three venous factors (type of anastomosis, venous outflow, and vein selection). ResultsThe average patient age was 52 years, with the majority (75.6%) being male. Eight patients (18.2%) returned to the operating room due to venous thrombosis, and five patients (11.4%) experienced total flap failure. The following factors were suspected to have contributed to venous thrombosis: vein size mismatch (n = 2) and recipient vein insufficiency possibly due to post-traumatic vessel disease (PTVD) (n = 6). End-to-side (ETS) anastomoses showed lower venous thrombosis rates than end-to-end (ETE) anastomoses (6.3% versus 25%, p = 0.22), two-vein outflows had lower rates than one (8.3% versus 30%, p = 0.07), and deep veins had the lowest thrombosis rates (7.7%), whereas superficial veins had the highest (38.5%). ConclusionThe key venous factors in preventing venous thrombosis include using as many two-vein ETS anastomoses as possible to deep recipient veins.

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“…[26][27][28][29][30] In lower extremity reconstruction, the advantages of end-to-side anastomosis are well established. 31,32 Preoperative revascularization with percutaneous interventions usually ensures enough blood flow to the very distal parts, but because many patients have essentially one-vessel leg, only end-to-side anastomosis should be used for reconstruction. The anastomosis using T-or Y-shaped vessel grafts also can be used in damaged or difficult anastomosis with reconstitution of distal run-off.…”

Section: Figurementioning

confidence: 99%

Vein conduit for end-to-side anastomosis of a calcified vessel in lower extremity free flap reconstruction

Kim

Lee

Moon

et al. 2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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A retrospective study of end-to-side venous anastomosis for free flap in extremity reconstruction

Abstract: These results confirmed that the success rate of ETS anastomosis was not affected by the local conditions of surgery site.

Cited by 11 publications

References 25 publications

Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report

Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report

Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap

Vein conduit for end-to-side anastomosis of a calcified vessel in lower extremity free flap reconstruction

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