Classification of Recipient Veins in Microsurgical Flap Reconstructions of the Lower Extremities

Abstract

It is difficult to cure severe open fractures of the lower extremities due to the frequent occurrence of severe damage to soft tissues or blood vessels, as well as bone defects, and concomitant infection, such as osteomyelitis. If appropriate treatment is not performed, long-term complications, such as nonunion of the bone, intractable ulcers, or other disorders, may arise. Between 1993 and 2010, we reviewed the records of 27 patients, and 28 limbs were treated. A total of 31 free-tissue transfers were performed on these 28 limbs. In this study, we classified the degree of damage based on the operative appearance of the condition of the recipient vein. A state that was normal or near-normal was described as type I-normal. A vein that was buried under a scar, but was comparatively easy to detach and retained a moderate adventitia was classified as type II-moderate. A vein with close adhesion between the wall and the scar that was not easy to detach was described as type III-severe. We also examined the relationships between recipient vein type and each of the following: (1) concomitant injury, (2) bone reconstruction, (3) preoperative infection, (4) length of time from injury to reconstruction, (5) eventual reoperation, and (6) flap necrosis. The results showed that there was a statistically significant relationship between recipient vein type and each of the following: bone reconstruction, preoperative infection, eventual reoperation, and flap necrosis. The selection of recipient vein is a factor that greatly affects the outcome of reconstruction of open fractures of the lower extremities. It is important to preoperatively estimate the condition of recipient vein even though it is difficult to preoperatively assess the condition. In some cases, only recipient veins in poor condition can be found intraoperatively on the affected leg. Under such circumstances, a cross-leg flap or a vein graft should be performed without hesitation to use recipient veins in a better condition.

The impact of pre-existing venous pathology on lower limb free flap reconstruction and the role of preoperative screening: a systematic review

“…A total of 11 articles were eligible for inclusion, including three case reports (8–10), three case series (11–13), and five retrospective studies (Fig. 1) (14–16).…”

“…Based on the MDB Quality Assessment Tool (5,17), three papers were of good quality (14,15,18) and two were of fair quality (16,19). None of the studies reported the reliability or validity of the paper, nor did they report the sample size or power calculation.…”

“…However, all but Valerio et al (15) provided evidence of random variability in the data. Kusano et al (16) did not provide clear objectives of their study and therefore the results were not summarized within the context of specific objectives. While Valerio et al (15) lost no patients to follow-up, no other papers stated whether there were any losses of patients to follow-up.…”

“…All papers described the characteristics of included patients; however, as Valerio et al (15) assessed a larger group of patients than those solely receiving lower limb free flaps, their method for grouping patients meant that the demographic information did not clearly state the ages or co-morbidities specific to the patient group of interest for this paper. Three papers described their limitations, yet this was not done in the studies by Kusano et al (16) or Janohofer et al (19) (Supplement Table 1).…”

Communications and correspondence: Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction

“…4,5 In summary, we would like to state that the evidence in the article suggesting that acute free flap reconstruction within the zone of trauma is safe might not be conclusive, and that more clinical experience including larger number of patients and different kind of flaps may help to bring more valuable knowledge in this topic.…”