Meta-analysis of venous anastomosis techniques in free flap reconstruction

Geierlehner, Alexander; Rodi, Timo; Mosahebi, Afshin; Tanos, Grigorios; Wormald, Justin C.R.

doi:10.1016/j.bjps.2019.11.033

Cited by 12 publications

(9 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The venous coupler was used because of the reduced post-operative thrombosis risk and the shorter ischaemia time compared to hand-sewn venous anastomosis [32,33].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Müller‐Seubert

Horch

Schmidt

et al. 2020

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction Soft tissue reconstruction of the hand and distal upper extremity is challenging to preserve the function of the hand as good as possible. Therefore, a thin flap has been shown to be useful. In this retrospective study, we aimed to show the use of the free temporoparietal fascial flap in soft tissue reconstruction of the hand and distal upper extremity. Methods We analysed the outcome of free temporoparietal fascial flaps that were used between the years 2007and 2016 at our institution. Major and minor complications, defect location and donor site morbidity were the main fields of interest. Results 14 patients received a free temporoparietal fascial flap for soft tissue reconstruction of the distal upper extremity. Minor complications were noted in three patients and major complications in two patients. Total flap necrosis occurred in one patient. Conclusion The free temporoparietal fascial flap is a useful tool in reconstructive surgery of the hand and the distal upper extremity with a low donor site morbidity and moderate rates of major and minor complications.

show abstract

“…The venous coupler was used because of the reduced post-operative thrombosis risk and the shorter ischaemia time compared to hand-sewn venous anastomosis [32,33].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Müller‐Seubert

Horch

Schmidt

et al. 2020

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

show abstract

“…Systematic analyses have shown that using coupler devices for venous anastomosis compared with hand sewn anastomosis reduces venous complications and improves flap survival. 10,11 Interestingly, for breast reconstructions, Mauch et al 5 showed no differences in venous complications in the left versus right side with coupling device use, although left-side couplers were significantly smaller than right-side couplers. 5 Therefore, we must leave the question undecided and consider that technical error might affect the anastomosis of extra small left-side IMVs despite the surgeon's vast experience performing general microsurgery.…”

Section: Discussionmentioning

confidence: 99%

Revision Rates of Left and Right Breast Reconstruction Differ With DIEP Flaps

Han

Eom

2021

Ann Plast Surg

View full text Add to dashboard Cite

Background: The internal mammary system provides the recipient vessel of choice in free autologous tissue breast reconstruction. However, left internal mammary veins (IMVs) are smaller than right IMVs, thus raising questions about their reliability. Here we analyzed right and left breast deep inferior epigastric perforator (DIEP) flap reconstruction performed by an experienced versus less experienced surgeon and hypothesized that less experienced surgeons might encounter difficulty in cases of smaller left IMVs. Methods: We respectively reviewed the charts of 714 DIEP flap breast reconstructions performed by an experienced surgeon (>15 years' DIEP flap experience) and 231 performed by a relatively inexperienced surgeon (<4 years' DIEP flap experience). Reconstructions requiring microvascular revisions were compared with nonrevision controls, and left-side reconstructions were compared with right-side controls. Results: Preoperative risk factors were not significantly different between the left and right cohorts for either surgeon. The experienced surgeon performed 17 microvascular revisions (2.4%), including 9 left (52.9%) and 8 right (47.1%). The less experienced surgeon performed 7 microvascular revisions (3.0%), all left. The left-and right-side revision rates were 2.4% and 2.3% for the experienced surgeon versus 6.1% and 0% for the less experienced surgeon, respectively, with a higher rate for the left side (P = 0.0299). Conclusions: The left-side microvascular revision rate was higher for the less experienced surgeon. Considering that left IMVs are smaller, less experienced surgeons should carefully perform left-side free flap breast reconstructions and be prepared to convert to thoracodorsal recipient vessel use.

show abstract

“…In comparison to PPFs, free flaps may lead to increased rates of arterial insufficiency and venous congestion due to the added surgical step of arterial and venous anastomosis. 37,38 Karjalainen et al performed a meta-analysis of 6,693 local flaps used for soft-tissue reconstruction of the digits, reporting 225 of 359 total complications were due to vascular compromise, primarily involving the arterial anastamosis. 39 Further, soft-tissue upper extremity reconstruction with free flap coverage has previously been identified to have an arterial thrombosis and venous congestion rate of 5.0 and 8.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Bovill

Huffman

Cach

et al. 2024

Journal of Hand and Microsurgery

View full text Add to dashboard Cite

Background Propeller perforator flaps (PPFs) have increased in popularity due to the freedom in design and ability to cover a variety of defects without sacrificing the major vessels. Present reports of PPFs for upper limb reconstruction have not provided guidance for hand reconstruction, specifically. This study aims to review the current literature and evaluate techniques for use of PPFs in hand reconstruction. Methods A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published from 1991 to 2021. The database search was queried for records using appropriate Medical Subject Headings (MeSH) terms. Studies reporting PPFs were limited to English language and excluded lower extremity or upper extremity reconstruction not specific to defects in the hand or digits. Study characteristics, patient demographics, indications, preoperative testing, flap characteristics, flap survival, and complication rates were collected. Results Out of the initial 1,348 citations yielded, 71 underwent full-text review. Ultimately, 25 unique citations were included encompassing 12 retrospective reviews (48%), 3 prospective cohort studies (10%), and 10 case series (40%). In review, 525 patients underwent reconstruction with a total of 613 propeller flaps performed to repair defects of the hand, digits, or both with use of 18 unique flap types. Overall flap survival was 97.8%. Acute wounds accounted for 72.9% of performed reconstructions. The mean flap coverage was 14.7 cm2. Complications occurred in 19.8% of cases, with venous congestion and partial flap necrosis occurring in 5.5 and 6.5% of cases, respectively, leading to a flap failure rate of 2.1%. Conclusion PPFs are a reliable option for hand or digital reconstruction, allowing surgeons to cover a variety of defects without sacrificing local vasculature. Despite nearly a 20% reported complication rate, nearly all flaps with venous congestion and partial flap necrosis included in these articles resolved without the need for secondary intervention, retaining an excellent overall flap survival.

show abstract

Meta-analysis of venous anastomosis techniques in free flap reconstruction

Cited by 12 publications

References 45 publications

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

Revision Rates of Left and Right Breast Reconstruction Differ With DIEP Flaps

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Contact Info

Product

Resources

About