Artery Grafting for Arterial Anastomoses in Head and Neck Free Tissue Transfer Reconstruction

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-09-13 DOI:10.1002/micr.31232
Eric V. Mastrolonardo, Pablo Llerena, Dev R. Amin, Emma De Ravin, Kathryn Nunes, Kelly M. Bridgham, Daniel J. Campbell, Ramez Philips, Shaum Sridharan, Andrés Bur, Ryan Heffelfinger, Mark K. Wax, Joseph M. Curry
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引用次数: 0

Abstract

Background

Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects.

Methods

A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported.

Results

Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (n = 3) and facial artery (n = 3) were the most commonly harvested arteries. The scalp (n = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (n = 4) or similarities in wall thickness (n = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses.

Conclusions

When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.

头颈部游离组织转移重建中的动脉吻合移植术
背景血管移植是头颈部游离组织转移(FTT)重建中的一项重要技术,否则无法进行无张力吻合。据我们所知,有关头颈部重建中动脉吻合的间位动脉移植的数据非常有限。在此,我们介绍了一个多机构的头颈部缺损 FTT 重建动脉插管移植物队列。 方法 在四家三级医疗机构对接受头颈部缺损 FTT 重建术的患者进行了回顾性审查,这些患者在动脉吻合时使用了插位动脉移植物。对病历进行了审查,内容包括所采集动脉移植物的类型和长度、手术指征、动脉移植物的指征、所采集皮瓣的类型以及各种术前特征(包括放射史或既往接受过 FTT 重建手术)。对术后 30 天内的术后并发症进行了测量和报告。 结果 九名患者符合纳入标准。最常采集的动脉是股外侧环动脉(横支或降支)(3 例)和面动脉(3 例)。头皮(5 例)是最常见的主要缺损部位。七例移植物是按计划初次采集的,两例是作为抢救技术(皮瓣抢救或静脉移植物失败)采集的。在有计划的移植物中,动脉是首选的插管移植物方法,原因是移植物和受体动脉的尺寸匹配(4 例)或壁厚相似(3 例)。据报道,没有出现意外再入院、术后血肿、瘘管形成、伤口感染或供体部位发病的病例。有两名患者因皮瓣受损而需要意外返回手术室,这两名患者最终都因动脉和静脉吻合处血块形成而导致皮瓣失败。 结论 当动脉蒂长度不足时,对于某些高度复杂的头颈部游离组织重建病例,间位动脉移植是一种可行的无张力动脉吻合技术。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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