Abstract
BackgroundVenous thrombosis has been shown to be the most frequent cause of free flap failure in traumatic lower extremity injuries. However, the roles of various anastomotic venous factors, including venous anastomosis (end-to-end (ETE) or end-to-side (ETS)), venous outflow (one vein or two veins), and recipient venous selection (deep or superficial vein), remain unclear. This retrospective study aims to investigate factors contributing to microvascular complications in patients with lower extremity Gustilo type IIIB/IIIC injuries reconstructed by free flap with a focus on the three abovementioned venous factors.MethodsA total of 44 flap treatment outcomes of 41 patients with these injuries from 2015 to 2020 were assessed according to the three venous factors (type of anastomosis, venous outflow, and vein selection).ResultsThe average patient age was 52 years, with the majority (75.6%) being male. Eight patients (18.2%) returned to the operating room due to venous thrombosis, and five patients (11.4%) experienced total flap failure. The following factors were suspected to have contributed to venous thrombosis: vein size mismatch (n = 2) and recipient vein insufficiency possibly due to post-traumatic vessel disease (PTVD) (n = 6). End-to-side (ETS) anastomoses showed lower venous thrombosis rates than end-to-end (ETE) anastomoses (6.3% versus 25%, p = 0.22), two-vein outflows had lower rates than one (8.3% versus 30%, p = 0.07), and deep veins had the lowest thrombosis rates (7.7%), whereas superficial veins had the highest (38.5%).ConclusionThe key venous factors in preventing venous thrombosis include using as many two-vein ETS anastomoses as possible to deep recipient veins.
Highlights
Severe traumatic lower extremity injuries involving open fractures (Gustilo type IIIB and IIIC) often require free flap coverage for limb salvage
The following factors were suspected to have contributed to venous thrombosis: vein size mismatch (n = 2) and recipient vein insufficiency possibly due to post-traumatic vessel disease (PTVD) (n = 6)
This study aims to investigate factors contributing to microvascular complications in lower extremity Gustilo type IIIB/IIIC injuries reconstructed by free flap with a focus on the three venous factors mentioned above
Summary
Severe traumatic lower extremity injuries involving open fractures (Gustilo type IIIB and IIIC) often require free flap coverage for limb salvage. Microsurgical techniques are more advanced than ever before, these injuries can be challenging to reconstruct because of a higher rate of complications, including flap failure, than in any other anatomical region [1] Multiple factors impact these complications, and whereas individual factors such as the degree of traumatic injuries and zone of injury cannot be controlled, procedural factors may offer areas for potential improvement, the identification of healthy, reliable recipient vessels and the methods and types of anastomoses formed between recipient and donor vessels. The roles of various anastomotic venous factors, including venous anastomosis (end-to-end (ETE) or end-to-side (ETS)), venous outflow (one vein or two veins), and recipient venous selection (deep or superficial vein), remain unclear This retrospective study aims to investigate factors contributing to microvascular complications in patients with lower extremity Gustilo type IIIB/IIIC injuries reconstructed by free flap with a focus on the three abovementioned venous factors
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