Less Is More? Impact of Single Venous Anastomosis on the Intrinsic Transit Time of Free Flaps.

Dornseifer, Ulf; Kleeberger, Charlotte; Kimelman, Michael; Kargl, Lukas; Holm, Charlotte; Moog, Philipp; Ninkovic, Milomir

doi:10.1055/s-0036-1593768

2017

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Title:: Less Is More? Impact of Single Venous Anastomosis on the Intrinsic Transit Time of Free Flaps.
Document type:: Journal Article
Author(s):: Dornseifer, Ulf; Kleeberger, Charlotte; Kimelman, Michael; Kargl, Lukas; Holm, Charlotte; Moog, Philipp; Ninkovic, Milomir
Abstract:: The number of venous anastomoses advisable for a free flap continues to be controversial. Intrinsic transit time (ITT) is the time it takes dye during indocyanine green (ICG) microangiography to travel from the arterial to the venous anastomosis. ITT provides information on blood flow velocity and can predict postoperative circulatory complications. This study investigated the effect of the number of venous anastomoses on ITT. The study enrolled 126 patients who had undergone microsurgical reconstruction and intraoperative ICG microangiography. Selection was limited to free gracilis and anterolateral thigh flaps as flaps with a single venous system. The retrospective assessment included reconstruction characteristics of the flaps, clinical outcome, ITT, and the number of venous anastomoses. The two groups were homogenous in terms of reconstruction characteristics. The single-venous anastomosis group ( = 75) had a reduced ITT (23.6 ± 11.7 vs. 43.8 ± 23.7 seconds; < 0.001) compared with the double-anastomosis group ( = 51). A shorter ITT resulted in a significant reduction in the risk of reexploration for anastomotic thrombosis (OR 0.96; = 0.024). Despite this, a higher reexploration rate tended to occur in the single-venous anastomosis group (9.3 vs. 7.8%; = 1.0). The results highlight the effect of shortening the ITT (thromboprotective blood flow acceleration) by using only one venous anastomosis. However, if the ITT is already at a low enough level with two veins, restriction to one vein does not appear to result in a reduced reexploration rate. For these flaps, the advantages of double-venous anastomosis prevail in terms of a backup drainage.
Journal title abbreviation:: J Reconstr Microsurg
Year:: 2017
Journal volume:: 33
Journal issue:: 2
Pages contribution:: 137-142
Language:: eng
Fulltext / DOI:: doi:10.1055/s-0036-1593768
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/27855467
Print-ISSN:: 0743-684X
TUM Institution:: Lehrstuhl für Plastische Chirurgie und Handchirurgie (Prof. Machens)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie (Prof. Machens)Lehrstuhl für Plastische Chirurgie und Handchirurgie (Prof. Machens)2017