Analysis of the Effects of Arterial Anastomosis Techniques and Vein Selection in Free Flap Surgery After Extremity Trauma

Background

Decision making about the selection of artery and vein anastomosis techniques is a challenging dilemma in free flap surgery, especially in trauma cases in which it is difficult to distinguish the zone of injury. This study aimed to analyze the effects of the selection of end to end (ETE) or end to side (ETS) artery anastomosis, one or two venous anastomoses, and the deep or superficial venous anastomoses on the flap survival and re-exploration rates. We further aimed to investigate whether there were any differences between lower and upper extremity free flaps.

Patients and Methods

A total of 447 patients were included in the study. Upper and lower extremity reconstructions were performed in 281 and 166 patients, respectively. The most commonly used flap was the anterolateral thigh (ALT) flap (42%). Flap survival and re-exploration status, number of recipient veins, deep/concomitant or superficial/subcutaneous venous anastomosis, and type of arterial anastomosis were analyzed.

Results

The overall flap survival rate was 94.9%. Flap re-exploration and flap failure rates were higher in the ETE group, although the difference was not statistically significant. Single venous anastomosis was performed in 56.8% of flaps. Most flaps were anastomosed with the deep/concomitant venous system (45.6%). There were no statistically significant differences regarding these venous anastomosis data. There was not any statistically significant difference between upper and lower extremities, either.

Conclusion

ETS or ETE arterial anastomosis, number of the veins or the selection of the deep/concomitant or superficial/subcutaneous system do not affect the flap survival and re-exploration rates, so the decision should be made according to the flap strategy or the condition of the vessels regarding the zone of injury. All techniques provide similar outcomes when performed properly.