The role of vein grafts in reconstructive head and neck microsurgery

Lai, Chih-Sheng; Chang, Yi Ling; Shen, Ching-Hui; Tsai, Yueh-Chi; Lu, Chen-Te; Yen, Jung-Hsing; Chen, I-Chen; Lin, Yi-Ling

doi:10.1016/j.bjorl.2021.09.004

Cited by 5 publications

(23 citation statements)

References 29 publications

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“…Vein grafts are a suitable alternative where there is significant tension on the arterial anastomosis and lack of additional available arteries. As such, vein grafts are usually required in patients with vessel‐depleted necks from prior radiation or those with previous free flaps, indicating a specific patient population that is high risk for flap failure 15–17 . Arterial grafts were less likely to be used in our respondents (20.0%).…”

Section: Discussionmentioning

confidence: 88%

“…As such, vein grafts are usually required in patients with vessel-depleted necks from prior radiation or those with previous free flaps, indicating a specific patient population that is high risk for flap failure. [15][16][17] Arterial grafts were less likely to be used in our respondents (20.0%). Although arterial grafts are a better match for arterial anastomosis because of the inherent ability of the arterial wall to withstand high pressure, their use can prevent future utility of an associated flap such as the radial or lateral circumflex femoral artery.…”

Section: Arterial Anastomosismentioning

confidence: 85%

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A Survey of Microvascular Technique Preferences Among American Head Neck Society Members

Philips,

Best,

Agarwal

et al. 2023

The Laryngoscope

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ObjectiveTo identify practices in microvascular techniques in routine and challenging scenarios.Study DesignCross‐sectional study.MethodsA national survey addressing practices related to microvascular free flap reconstruction was distributed to AHNS members between October and November 2021.ResultsThe respondents encompassed 95 microvascular surgeons. Median years of practice was 6 (interquartile range, 2–13) and median flaps per year was 35 (22–50). Common practices in arterial anastomosis included limited cleaning of artery (84.2%), use of a double approximating clamp (64.2%), and use of interrupted suture (88.4%). Common practices in venous anastomosis included limited cleaning (89.5%), downsizing the coupler (53.7%), and coupling to two independent venous systems (47.4%). In arterial anastomosis, respondents felt that kinking (50.5%) and tension (24.2%) were the riskiest challenges. Kinking was handled by loose sutures or native tissue/dissolvable biomaterial to orient pedicle. Excess tension was handled by additional dissection. With regards to associated practices, most surgeons perform anastomosis after partial inset (52.6%), give aspirin immediately postoperatively (66.3%), reserve transfusion for hemodynamic instability (69.5%), and utilize intraoperative pressors when needed (72.6%). More senior surgeons reported placing more suture to address leaks (p = 0.004) and perform end to side anastomosis on larger vein in case of venous mismatch (p = 0.012). In cases of tension, higher volume surgeons perform more extensive dissection (p = 0.035) and end to side coupling (p = 0.029).ConclusionsThis survey of AHNS members indicates patterns of microvascular techniques in routine and challenging scenarios. There exists a variation in approaches amongst surgeons based on volume and practice length.Level of Evidence5 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 88%

Section: Arterial Anastomosismentioning

confidence: 85%

A Survey of Microvascular Technique Preferences Among American Head Neck Society Members

Philips,

Best,

Agarwal

et al. 2023

The Laryngoscope

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“…21,24,26 Later studies disagree regarding influence of vein grafting on flap survival. Kapila et al and Swendseid et al 7,38 found that vein grafts were associated with higher rates of flap failure or takebacks, whereas Di Taranto et al and Lai et al 16,29 found that vein grafts were not associated with higher risk of flap failure. This study shows vein grafts used in the primary operation to lengthen the pedicle were not associated with flap failure.…”

Section: Discussionmentioning

confidence: 99%

“…4 5 6 7 However, other studies have found no increased risk of flap loss or complications, 8 9 10 11 12 13 14 even in salvage procedures. 15 Other literature has indicated that vein grafts are only associated with higher rates of complications, but not flap loss, 16 or only associated with flap loss under certain conditions. 17 This conflicting literature points to an association that may be nuanced and multifactorial 18 : operations requiring vein grafting tend to be more complex than those that do not require vein grafting and unexpected vein grafts can prolong flap ischemia time.…”

mentioning

confidence: 99%

Comparisons of Impact of Vein Grafting with Different Indications on Outcomes of Reconstruction with Free Flaps

Coriddi,

Kim,

Haglich

et al. 2024

J Reconstr Microsurg

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Introduction: Prior studies have shown an increased risk of complications and flap loss with the use of vein grafts in microsurgery. We hypothesize that indication for use of a vein graft can affect flap complications and loss rates. Methods: We performed a retrospective review of all patients at our institution from 2010-2020 who underwent free flap reconstruction and required use of a vein graft. Indications for vein grafting included: salvage of flap during primary operation after microvascular compromise; augmentation of flow during primary operation; lengthening of the flap pedicle during the primary operation; and salvage of the flap during a secondary salvage operation after microvascular compromise. Results: 79 patients met the study inclusion criteria. There were significant differences among the vein graft indication groups and the following: area of reconstruction (p=0.002), vein graft length (p=0.018), vessels grafted (p=0.001), vein graft donor site (p=0.011), and total flap loss (p=0.047). Of the four indications for vein grafting, salvage of the flap during secondary salvage operation after microvascular compromise had the highest rate of total flap loss (26.7%). There were no significant associations between other flap complications and vein graft indications. Conclusions: Vein graft use in the primary reconstructive setting is efficatious, with low risk of thrombosis. Use in secondary procedures however is associated with higher rates of total flap loss, likely due to the thrombotic process which was initiated prior to the use of the graft resulting in the salvage procedure and not secondary to the graft itself.

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“…If a longer ischemia time does not compromise the outcome of the procedure, the surgeon can spend more time on certain stages of the reconstruction, such as shaping and inserting the 543 fibula into the mandible or adding an osseointegrated dental implant. This length of time reduces the possibility of surgical errors due to rushed procedures [16][17][18][19].…”

mentioning

confidence: 99%

Factors Associated with Free Flap Viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Ismoyo

Muzakkie

Bahar

2023

sjs

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Introduction: A free flap is part of reconstructive surgery. This technique takes tissue or bone flaps along with their original vascular supply and performs microvascular anastomosis of the pedicle arteries and veins at the recipient site. Several risk factors that influence the occurrence of flap failure are still a major concern, such as age, gender, defect size, duration of surgery, length of tissue ischemic time, nutritional status, etc. This is further associated with higher morbidity, the potential for flap failure, higher costs, and increased length of stay in the hospital. This study aimed to determine the factors associated with free flap viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Methods: Cross-sectional analytic observational study. A total of 33 research subjects participated in this study. Observation of risk factors was carried out using SPSS univariate and bivariate. Results: Gender and ischemic time factors are related to free flap viability. Male gender and ischemic time < 60 minutes increase the success of free flap viability. Conclusion: Gender and length of ischemic time are associated with free flap viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

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The role of vein grafts in reconstructive head and neck microsurgery

Cited by 5 publications

References 29 publications

A Survey of Microvascular Technique Preferences Among American Head Neck Society Members

A Survey of Microvascular Technique Preferences Among American Head Neck Society Members

Comparisons of Impact of Vein Grafting with Different Indications on Outcomes of Reconstruction with Free Flaps

Factors Associated with Free Flap Viability at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

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