Vein grafting your way out of trouble: Examining the utility and efficacy of vein grafts in microsurgery

The retrograde transverse cervical artery as a recipient vessel for free tissue transfer in complex head and neck reconstruction with a vessel‐depleted neck

“…Furr et al () reported 95% free flap survival rate with the use of IVGs in head and neck reconstruction. On the other hand, other authors have reported up to 24% free flap loss when IVGs are used, especially in salvage cases (Nelson et al, ). In a review article examining the literature on prevention and treatment of thrombosis in microvascular surgery, Hanasono and Butler () considered vein graft use an unfavorable condition and suggested use of antithrombotic agents prophylactically after risk stratification.…”

“…While all these sources can provide a reliable arterial inflow, they often require additional incisions and sometimes long interposition venous graft to brigde the arterial gap (Biemer, 1977;Furr, Cannady, & Wax, 2011). Use of interposition vein grafts (IVG) in head and neck reconstruction remains controversial (Kruse, Luebbers, Gratz, & Obwegeser, 2010 (Nelson et al, 2015). In a review article examining the literature on prevention and treatment of thrombosis in microvascular surgery, Hanasono and Butler (2008) During recipient vessel exploration in a hostile neck with prior radiation, neck dissection, failed reconstruction, or cancer recurrence, we methodically search for reliable vessels as suggested in the literature (Urken et al, 1989).…”

The radial forearm free flap as a “vascular bridge” for secondary microsurgical head and neck reconstruction in a vessel‐depleted neck

“…For this reason, use of IVGs in head and neck reconstruction remains controversial (Kruse, Luebbers, Grätz, & Obwegeser, 2010). While free flap survival rates as high as 95% have been reported with their use in head and neck reconstruction, others have experienced free flap losses up to 24%, especially in salvage cases and when long vein segments are used (Furr et al, 2011;Nelson et al, 2015). A review on prevention and treatment of thrombosis in microvascular surgery suggested prophylactic use of antithrombotic agents when IVGs are used as it was considered an unfavorable condition (Hanasono & Butler, 2008).…”

“…In certain situations these options are either suboptimal due to the geometry of the pedicle or unavailable (Urken, Vickery, Weinberg, Buchbinder, & Biller, ). The thoracoacromial and internal mammary vessels have both been used in this context and many times vein grafts and arteriovenous loops are used to reach these relatively distant sites (Angel et al, ; Furr, Cannady, & Wax, ; Hanasono et al, ; Harris, Lueg, Genden, & Urken, ; Jacobson, Smith, & Urken, ; Lin et al, ; Miller, Schusterman, Reece, & Kroll, ; Nelson et al, ; Roche, Houtmeyers, Vermeersch, Stillaert, & Blondeel, ; Urban & Fritsche, ; Urken, Higgins, Lee, & Vickery, ; Wong et al, ; Yagi, Kamei, Fujimoto, & Torii, ). Nevertheless, the severely fibrotic nature of the irradiated neck tissue may not be pliable enough to allow tunneling or reliable coverage of these vascular conduits, especially when the distance to be covered is large, resulting in compression, kinking, and eventual flap loss.…”

Recipient Vessel Thrombectomy and Anastomosis within the Zone of Injury in Microvascular Extremity Reconstruction

“…3,5,8,9 This may require extensive proximal dissection, alternative retrograde inflow distal to the zone of injury, 2,3 harvest of increased pedicle length, and the possible use of interpositional vein grafts. 10 However, more complex cases, such as those involving massive trauma, limited donor sites, certain anatomic constraints, and/or limited pedicle lengths, may make pursuit of anastomosis outside the zone of injury unsuitably morbid. 2 Regardless of location, a vessel must have adequate flow to complete a successful microanastomosis.…”