Clinical Features of Primary Vein Grafts in Free Tissue Transfers

Abstract

The outcomes of free tissue transfers combined with vein grafts have been inconsistent, and discussions continue regarding their appropriate use. Of the 142 free tissue transfers that we performed from January 2004 to December 2011, we retrospectively analyzed 15 consecutive patients who underwent free tissue transfers in combination with vein grafts. Etiologies included trauma (8 patients), infection (4), and tumor (3). Types of free tissue transfers were fibula (4), anterolateral thigh (3), groin (3), jejunum (3), latissimus dorsi (1), and dorsal pedis (1). Vein grafts were used for the artery (6), vein (2), or both (7). The donor veins were the saphenous vein (12) and the external jugular vein (3). The mean length of the grafted veins was 10.8 cm (range: 4–18 cm). Even though complications of congestion occurred in 2 patients, these flaps survived by reexploration. The flap success rate was 15 of 15 (100%) of vein grafted free flaps versus 124 of 127 (97.6%) of free flaps not requiring vein grafts. To improve the success rate of free tissue transfers combined with vein grafts, securing healthy recipient vessels, meticulous surgical handling, a reliable vascular anastomosis technique, and strict postoperative monitoring are crucial.

Heparin-Eluting Electrospun Nanofiber Yarns for Antithrombotic Vascular Sutures

“…Vascular graft implantation and bypass surgery both rely upon suture-based anastomosis. Damage to the vascular endothelium at the site of anastomosis initiates the coagulation cascade, triggers a proinflammatory response, and activates smooth muscle cells, leading to major complications such as pathological clots (thrombosis) and progressive occlusion (stenosis). − Thus, there is a need for the design of bioactive sutures capable of inhibiting thrombosis and cellular activation. Another example illustrating the need for antithrombotic activity of sutures is the transplantation of tissue from one location, the “donor site”, to the desired location, the “recipient site”, with suture-based vascular anastomosis.…”

“…Thrombotic occlusion is the main cause of graft failure in free-tissue transfers, occurring in 4% of free flaps and up to 30% of digital replantation. To reduce the risk of these complications, systemic therapy with anticoagulant drugs is frequently required. ,,− Despite all these efforts, the challenge to mitigate the risk of thrombosis postsurgery still exists and needs to be addressed. , …”

Identification of the anatomy of the deep temporal vein using computed tomography imaging: A retrospective cross‐sectional review of patient imaging

“…The proximity of the DTV to the midface and scalp may avoid the need for interposition vein grafting, as a long pedicle is needed to reach veins in the neck. Single‐center studies have shown mixed results with regards to whether grafts increase the risk of flap failure, with assessment often compounded by the fact that populations requiring venous grafts have more co‐morbidities (Cheng et al, 2012; Chowlia et al, 2015; Classen, 2004; Germann & Steinau, 1996; Nemoto et al, 2015). However, avoiding the use of vein grafts can reduce operative time and potential donor site morbidity, and may reduce flap failure in the case of interposition grafts (Inbal et al, 2018).…”

Highly Aligned Electrospun Collagen/Polycaprolactone Surgical Sutures with Sustained Release of Growth Factors for Wound Regeneration

“…Surgical regeneration of connective tissues such as vascular, tendons, and viable tissues remains a long-standing clinical challenge, primarily because insufficient treatment, repair, and even failure of injured sites by insufficient regeneration often cause unwanted inflammatory, pathological thrombosis, and progressive occlusion. , Drug-eluting surgical sutures have been commonly used as delivery depots for antibiotics, anti-inflammatory, and anesthetics at surgical sites . While adding chemical drug have repaired the injured to some extents, they are still limited by insufficiently regulating of the initial subsequent healing process.…”