Optimizing venous outflow in reconstruction of Gustilo IIIB lower extremity traumas with soft tissue free flap coverage: Are two veins better than one?

Stranix, John T.; Lee, Z‐Hye; Anzai, Lavinia; Jacoby, Adam; Avraham, Tomer; Saadeh, Pierre B.; Levine, Jamie P.; Thanik, Vishal

doi:10.1002/micr.30271

Cited by 40 publications

(68 citation statements)

References 18 publications

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“…Therefore, further investigation will be needed. However, The PAP flap transfer with two venous system drainages lowers the chances of congestion due to thrombosis, thus decreases flap failure and partial fat necrosis rates (Ahmadi, Herle, Rozen, & Leong, ; Riot et al, ; Stranix et al, ). The accessory saphenous vein can also be used for super‐drainage in pedicled propeller PAP flap transfer, in which a flap can result in congestion due to kinking of the pedicle.…”

Section: Discussionmentioning

confidence: 99%

The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: A cadaveric study and clinical application

et al. 2019

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Background The profunda femoris artery perforator (PAP) flap is gaining popularity in microsurgical reconstruction. To establish a safer flap elevation technique, we focused on the topology of the accessory saphenous vein in the medial thigh area. We hypothesize that including the accessory saphenous vein in a PAP flap results in safer PAP flap transfer with two venous drainage systems. The aim of this study was to describe the anatomical relationship between the perforators and the accessory saphenous vein in the PAP flap using fresh cadavers and to describe the relationship through two clinical cases. Methods For the anatomical study, 19 posterior medial thigh regions from 10 fresh cadavers were dissected. We recorded the number, site of origin, the length, and the diameter of the pedicle. We also documented the course, the length, and the diameter of the accessory saphenous vein. PAP flap transfer with additional accessory saphenous vein anastomosis was performed in two clinical cases; a 40‐year‐old female with tongue cancer and a 51‐year‐old female with breast cancer. Results In all cadaveric specimens, the accessory saphenous vein was found above the deep fascia. The average distance between the proximal thigh crease and the intersection of the anterior edge of the gracilis muscle and the accessory saphenous vein was 7.7 ± 2.5 cm. The diameter of the accessory saphenous vein averaged 3.1 ± 1.1 mm. The average accessory saphenous vein length from its takeoff from the great saphenous vein to the anterior edge of the gracilis muscle was 4.2 ± 1.3 cm. In clinical cases, the flap size was 6 x 18 cm and 8 x 21 cm and the follow‐up length was 12 and 3 months, respectively. In both cases, the postoperative course was uneventful and the flap survived completely. Conclusion Anatomical study confirmed that the accessory saphenous vein did exist in all specimens and it could be included in the PAP flap with sufficient length and relatively large diameter. Although further clinical investigation will be required to confirm its efficacy, a PAP flap including the accessory saphenous vein may decrease the chances of flap congestion.

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Section: Discussionmentioning

confidence: 99%

The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: A cadaveric study and clinical application

et al. 2019

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“…44 However, more recent data suggest that dual venous outflow is associated with improved outcomes and reduced rates of failure. [45][46][47] Additionally, the reduction in operative time is effectively doubled in the setting of a second venous anastomosis. While the impact of reduced operative times is unclear at present both clinically and from a cost-analysis perspective, the more tendency toward more frequent establishment of dual venous outflow may significantly improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hand-Sewn versus Coupled Venous Anastomoses in Traumatic Lower Extremity Reconstruction

Stranix

Rifkin

Lee

et al. 2018

J reconstr Microsurg

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“…Sometimes circumferential coverage is needed and post-operative edema and scarring have to be taken into consideration [18] . Therefore, lower limb reconstruction is one of the most challenging, with a higher incidence of free flap loss compared to microsurgical reconstructions performed in other districts [19][20][21][22][23] . Patients in need of lower extremity reconstruction also include various number of traumatic injuries.…”

Section: Lower Extremitymentioning

confidence: 99%

“…Despite this, the management of these complex injuries is still debated. It has been demonstrated by several studies that vascular injury increases the severity of trauma [23] . Stranix et al [20] , compared Gustilo IIIB injuries with increasing arterial injury, finding that limbs with a single vessel uninjured had higher flap failure risk [20] .…”

Section: Devascularized Limbsmentioning

confidence: 99%

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Bolletta¹,

Rubino²,

Chen³

2019

PAR

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In the recent decades, microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic outcome. This review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb preservation. In the upper extremity, it is important to restore fine motility, together with allowing prompt mobilization. In the lower limb, care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing. Local perforator flaps can be considered for medium size defects. They provide thin coverage and can be performed in short operating time. Their use, though, is often limited by tissue availability. Free flaps allow to overcome this problem and, thanks to the recent development in the study of perforator vessels, the microsurgeon can choose the flap with the most appropriate characteristics. Chimeric flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone reconstruction. When dealing with limb preservation it is very important to consider residual functionality. Functioning muscle transfer and targeted muscle re-innervation can be performed in these cases. A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free flaps. In conclusion, extremity reconstruction and limb preservation are reaching new heights thanks, not only to the work of plastic surgeons, but also to the new developments in other fields of study such as oncology, traumatology, radiology and medical engineering.

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Optimizing venous outflow in reconstruction of Gustilo IIIB lower extremity traumas with soft tissue free flap coverage: Are two veins better than one?

Cited by 40 publications

References 18 publications

The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: A cadaveric study and clinical application

The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: A cadaveric study and clinical application

Comparison of Hand-Sewn versus Coupled Venous Anastomoses in Traumatic Lower Extremity Reconstruction

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

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