Does the use of arteriovenous loops increase complications rates in posttraumatic microsurgical lower extremity reconstruction?A matched-pair analysis
Does the use of arteriovenous loops increase complications rates in posttraumatic microsurgical lower extremity reconstruction?A matched-pair analysis
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DOI：
10.1002/micr.30197
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发表时间：
2018-09-01
期刊：
影响因子：
2.1
通讯作者：
Kovach, Stephen J.
中科院分区：
文献类型：
--
作者：
Momeni, Arash;Lanni, Michael A.;Kovach, Stephen J.
动静脉袢在显微外科下肢重建中的应用是一个有争议的话题。本研究的目的是评估AV环对创伤后下肢缺损显微手术重建后并发症发生率的影响。患者和方法将接受创伤后缺损自由皮瓣覆盖联合AV环的患者（1组）与接受无静脉移植重建的患者（2组）进行年龄、体重指数（BMI）、吸烟、缺损位置和皮瓣类型匹配。结果包括并发症发生率和皮瓣丢失率。结果1组10例，平均年龄51岁（范围21 ~ 79岁），2组平均年龄47.3岁（范围22 ~ 69岁）（P=0.596）。在皮瓣丢失（P=1.0）、术中（P=0.474）和术后并发症发生率[手术部位感染（P=1.0）、出血（P=1.0）、伤口延迟愈合（P=0.23）、裂开（P=0.58）和骨不连（P=1.0）]方面，两组无差异。第1组仅有1个皮瓣丢失。组间差异仅为手术时间延长（P=0.03）、住院时间延长（P=0.009）。结论采用静脉移植物建立房室环后进行一期游离皮瓣移植重建创伤后下肢缺损，其重建效果与不需要静脉移植物的患者相似。
IntroductionThe use of arteriovenous (AV) loops in microsurgical lower extremity reconstruction is a controversial topic. The objective of the present study was to assess the impact of AV loops on complication rates following microsurgical reconstruction of posttraumatic lower extremity defects.Patients and MethodsPatients who underwent free flap coverage of posttraumatic defects in combination with an AV loop (Group 1) were identified and matched for age, body mass index (BMI), tobacco use, defect location, and flap type with patients who underwent reconstruction without vein grafts (Group 2). Outcomes of interest included complication rate and flap loss rate.ResultsGroups 1 and 2 consisted of 10 patients each with a mean age of 51 years (range, 21-79 years) and 47.3 years (range, 22-69 years), respectively (P=0.596). No differences were noted regarding flap loss (P=1.0), intraoperative (P=0.474) or postoperative complication rate [surgical site infection (P=1.0), bleeding (P=1.0), delayed wound healing (P=0.23), dehiscence (P=0.58), and osseous non-union (P=1.0)]. Only one flap loss was noted in Group 1. The only differences were increased operative time (P=0.03) and increased length of stay (P=0.009) in Group 1.ConclusionOur results suggest that utilization of vein grafts with creation of AV loops followed by single-stage division and free flap transfer for reconstruction of posttraumatic lower extremity defects achieve reconstructive outcomes similar to those obtained in patients in whom no vein grafts are necessary.