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

Stranix, John T.; Rifkin, William J.; Lee, Z‐Hye; Anzai, Lavinia; Jacoby, Adam; Ceradini, Daniel J.; Thanik, Vishal; Saadeh, Pierre B.; Levine, Jamie P.

doi:10.1055/s-0038-1660831

Cited by 14 publications

(4 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Anastomotic couplers offer a superior alternative to hand-sewn methods, particularly, in cases of the anastomosis with a vein. Stanix et al 22 reported that the rates of complications and flap failure were similar between reconstructions performed using a venous coupler and those performed using hand-sewn venous anastomosis in lower extremity reconstructions, which have the highest reported rates of complications and flap failure among all anatomical regions. Conversely, in a systematic review of venous anastomotic couplers by Wu et al, 23 unique complications, such as coupler extrusion and palpability, were reported in cases with previous radiation exposure or thin, soft tissues (eg, head and neck, hands, and feet).…”

Section: Discussionmentioning

confidence: 99%

A Novel Method of End-to-Side Microvascular Anastomosis Using T-Shaped Metal Stents: A Porcine Study

Sugiura

Sarukawa

Kamochi

et al. 2021

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

End-to-side anastomosis requires highly specialized techniques. An easy end-to-side anastomosis technique enables anastomosis of vessels with different diameters and under various situations. We invented T-shaped metal stents and evaluated novel methods of end-to-side sutureless anastomosis, confirming their safety, effectiveness, and operability. We performed 8 end-to-side sutureless anastomoses in 4 7-to 11-month-old, male Mexican hairless piglets. After induction of anesthesia, the left femoral artery was resected by approximately 8 cm, and the superior and posterior stumps of the resected femoral artery underwent an end-to-side anastomosis with the right femoral artery by the placement of the metal stents with subsequent use of adhesive for the circumferential area. The patency of blood vessels and the presence of thrombosis were evaluated by ultrasonography or contrast-enhanced computed tomography and histology 4 weeks postoperatively. All the animals survived the procedure; no thrombosis was identified in any of the 8 anastomosis sites according to imaging studies performed 4 weeks postoperatively. Histological examination confirmed the probe patency of blood vessels and neointimal cell proliferation around stent branches. End-to-side anastomosis is possible with T-shaped metal stents. In the future, we aim for the practical application of these stents by improving their operability.

show abstract

Section: Discussionmentioning

confidence: 99%

A Novel Method of End-to-Side Microvascular Anastomosis Using T-Shaped Metal Stents: A Porcine Study

Sugiura

Sarukawa

Kamochi

et al. 2021

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

show abstract

“…There was a trend toward a lower rate of venous thrombosis when a venous coupler was used, as compared to a hand-sewn anastomosis. Venous coupler systems have become common practice in free flap transfer throughout the body and have shown favorable outcomes compared to handsewn venous anastomoses in terms of venous thrombosis rate, revision rate, and flap loss/failure [18][19][20][21][22] . Coupler size has been shown to be important in some flap transfer settings.…”

Section: Discussionmentioning

confidence: 99%

“…Venous coupler systems have become common practice in free flap transfer throughout the body and have shown favorable outcomes compared with hand-sewn venous anastomoses in terms of venous thrombosis rate, revision rate, and flap loss/failure. [19][20][21][22][23] Coupler size has been shown to be important in some flap transfer settings. In a review of 418 patients undergoing free tissue transfer for head and neck reconstruction using a venous coupler, multivariate analysis demonstrated a 41% reduction in revision rate for each increase in coupler size by 1 mm.…”

Section: Discussionmentioning

confidence: 99%

Technical Variables in Lower Extremity Free Flap Reconstruction

Christensen

Ahn

Meulendijks

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

Background: Lower extremity free flap failure rates are higher than in other areas of the body. While prior studies assessed the effect of intraoperative technical variables, these generally investigated individual variables and did not examine relationships between the many individual technical decisions made during a free tissue reconstruction. Purpose: Investigate the effect of variation in intraoperative microsurgical techniques on flap outcomes in a diverse cohort of patients requiring lower extremity free flap coverage. Methods: Consecutive patients undergoing free flap reconstruction of the lower extremity at two level 1 trauma centers from January 2002 to January 2020 were identified using CPT codes, followed by review of medical records. Demographics and comorbidities, indications, intraoperative technical details, and complications were collected. Outcomes of interest included unplanned return to the operating room, arterial thrombosis, venous thrombosis, partial flap failure, and total flap failure. Bivariate analysis was performed. Results: 410 patients underwent 420 free tissue transfers. Median follow up time was 17 months (IQR 8.0-37). Total flap failure occurred in 4.9% (n=20), partial flap failure in 5.9% (n=24), and unplanned reoperation in 9.0% (n=37), with arterial thrombosis in 3.2% (n=13), and venous thrombosis 5.4% (n=22). Overall complications were significantly associated with recipient artery choice, with arteries other than PT and AT/DP having a higher rate (p=0.033), and with arterial revisions (p=0.010). Total flap failure was also associated with revision of the arterial anastomosis (p=0.035), and partial flap failure was associated with recipient artery choice (p=0.032). Conclusions: Many interoperative options and techniques are available when performing microvascular lower extremity reconstruction that lead to equally high success rates. However, use of arterial inflow outside of the posterior tibial and anterior tibial arteries leads to a higher overall complication rate and partial flap failure rate. Intraoperative revision of the arterial anastomosis portends poorly for ultimate flap survival.

show abstract

“…The use of a coupling device has become common practice and increased the efficiency of free flap reconstruction without affecting flap outcomes. 32…”

Section: Technical Considerationsmentioning

confidence: 99%

Updates in Traumatic Lower Extremity Free Flap Reconstruction

Lee

Daar

et al. 2023

Plastic &Amp; Reconstructive Surgery

Self Cite

View full text Add to dashboard Cite

Summary: Lower extremity reconstruction, particularly in the setting of trauma, remains one of the most challenging tasks for the plastic surgeon. Advances in wound management and microsurgical techniques in conjunction with long-term outcomes studies have expanded possibilities for limb salvage, but many aspects of management have continued to rely on principles set forth by Gustilo and Godina in the 1980s. The purpose of this article is to provide a comprehensive update on the various management aspects of traumatic lower extremity microvascular reconstruction based on the latest evidence, with an examination of recent publications.

show abstract

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

Cited by 14 publications

References 51 publications

A Novel Method of End-to-Side Microvascular Anastomosis Using T-Shaped Metal Stents: A Porcine Study

A Novel Method of End-to-Side Microvascular Anastomosis Using T-Shaped Metal Stents: A Porcine Study

Technical Variables in Lower Extremity Free Flap Reconstruction

Updates in Traumatic Lower Extremity Free Flap Reconstruction

Contact Info

Product

Resources

About