The indications and reliability of vein graft use in free flap transfer

Classen, Dale A.

doi:10.4172/plastic-surgery.1000385

Cited by 10 publications

(14 citation statements)

References 13 publications

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“…Another precaution needed in this technique is the preparation of the vein graft. Vein grafts are widely used in microsurgical reconstruction (Classen, 2004;Hwee et al, 2020;Jandali et al, 2016;Kang & Kim, 2019). However, long vein grafts should be avoided, especially in this technique.…”

Section: Discussionmentioning

confidence: 99%

Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

Kim

Moon

2021

Microsurgery

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Background: With severe vascular calcifications, vascular clamp application and utilizing the vessel for free flap recipient vessel becomes impossible. These obstacles can be overcome with the Fogarty catheter and vein graft.Patients and methods: When unclampable artery was encountered intraoperatively, a vein graft was used to make a clampable recipient site for six diabetic foot patients (ages from 42 to 80). The end of the Fogarty catheter was inserted into the proximal end of the vein graft and the transected calcified vessel in sequence, and the balloon of the catheter was used as an intraluminal tourniquet. The remaining end of the vein graft was connected to the distal vessel with a vascular clamp.Results: Five short vein graft revascularization for segmental arterial occlusion, one long vein graft for recipient artery elongation was done (lengths from 2 to 13.8 cm).Three delayed, and two immediate anterolateral thigh flaps (sizes from 15 to 150 cm 2 ) were performed, and one patient received vein graft revascularization surgery only. Postoperative vascular sonography of all six patients showed wellmaintained patency. Minor flap marginal disruption occurred at two patients but healed with conservative care. Postoperative follow-up was done for 1-18 months (average 7.17). Limb salvage was achieved for five patients and all five free flaps survived. However, for one patient, arterial restenosis at popliteal artery a month later lead to major amputation. Conclusion:Using a Fogarty catheter and a vein graft may obtain perfect hemostasis during micro-anastomosis and achieve successful microvascular reconstruction in patients with severely calcified vessels.

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Section: Discussionmentioning

confidence: 99%

Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

Kim

Moon

2021

Microsurgery

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“…Despite concerns that vein grafts may increase the incidence of free flap thrombosis, 2,7 several studies have demonstrated that using vein grafts may not compromise overall flap success rates. 7,8 In this case series, arterial thrombosis leading to flap failure occurred in only one patient. The flap success rate and limb salvage rates in this series suggest that the possible risk of thrombosis posed by venous grafts should not preclude the use of this technique.…”

Section: Discussionmentioning

confidence: 72%

Saphenous Vein Interposition Grafts in Lower Extremity Reconstruction: Appraisal of Technique and Case Series

Dekker

Abdou

Youn

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Vascular microanastomosis is technically challenging in patients with calcified recipient and donor vessels. Inside-to-outside suturing can prevent plaque rupture and ensure full-thickness intimal approximation. Although this is the preferred technique for anastomosis of atherosclerotic vessels, direct connection of calcified arteries necessitates outside-to-inside suturing on one side of the anastomosis. Furthermore, it is difficult to achieve optimal vessel wall approximation in the setting of luminal size mismatch and rigid vasculature. We previously reported on the use of a saphenous vein interposition graft as a novel technique to achieve a flow-sparing anastomosis in patients with diffuse atherosclerosis who are undergoing free tissue transfer. This study further assesses outcomes of this technique in a series of patients and demonstrates a flap success rate of over 93% in patients with calcified recipient and donor microvasculature.

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“…Conversely, one of two flaps that required unplanned vein grafting intraoperatively failed. 25 Despite a small sample size, the study reminds surgeons to plan for a potential vein graft.…”

Section: Vein Grafts By Locationmentioning

confidence: 98%

Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls

Langdell

Shammas

Atia

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: Vein grafts enable soft-tissue reconstruction in cases of insufficient pedicle length, a lack of nearby recipient vessels, and a wide zone of injury caused by trauma or radiation therapy. The purpose of this article is to provide a comprehensive review of vein grafts in free flap reconstruction focusing on the timing of arteriovenous loops, complications, and surgical technique. Vein graft indications, types of vein grafts, and location-specific considerations are also reviewed. Three reconstructive microsurgeons at high-volume centers were asked to offer institutional pearls on the order of anastomosis, selection of donor veins, and timing of arteriovenous loops. In terms of gap length, vessel gaps less than 10 cm may be reconstructed with an interposition or transposition vein graft. For longer gaps, surgeons should consider the use of arteriovenous loops, transposition arteriovenous loops, or flow-through flaps. Both one and two-stage arteriovenous loops are used, depending on patient comorbidities, potential exposure of critical structures, and surgeon preference. Although one-stage arteriovenous loops expedite the reconstructive process, two-stage arteriovenous loops require shorter operations and help identify patients at risk of flap failure. Although whether the use of vein grafts increases flap failure rates is controversial, complications are highest in lower extremity reconstruction, cases of a prolonged interval between stages in two-stage arteriovenous loops, and unplanned vein grafts.

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The indications and reliability of vein graft use in free flap transfer

Cited by 10 publications

References 13 publications

Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft

Saphenous Vein Interposition Grafts in Lower Extremity Reconstruction: Appraisal of Technique and Case Series

Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls

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