Venous graft as temporary arteriovenous shunt in free tissue transfer

Outcome of simultaneous and staged microvascular free tissue transfer connected to arteriovenous loops in areas lacking recipient vessels

BACKGROUND

Arteriovenous loops are an indispensable tool in free flap surgery when appropriate recipient vessels are missing. In this study, the authors analyzed whether the outcome differs when flaps were transferred simultaneously or subsequently after construction of arteriovenous loops.

METHODS

Twenty-seven patients requiring free tissue transfer received arteriovenous loops by pedicled or free vein grafts because of inadequate local recipient vessels. In head and neck reconstruction, pedicled brachiocephalic or free saphenous vein grafts were anastomosed to cervical or axillary vessels. Pedicled major saphenous vein grafts were used in the pelvic area whereas, in lower leg and foot reconstruction, free saphenous or brachiocephalic veins were used. Flaps were transferred simultaneously (n = 10) or 4 to 17 days later (n = 17).

RESULTS

Thrombosis required revision in staged transfer (n = 3 patients) or in simultaneous flap transfer (n = 2). No free flap was lost. Fisher's exact test did not indicate a significant difference between a simultaneous or staged flap transfer.

CONCLUSIONS

Temporary arteriovenous loops provide adequate recipient vessels and flow to supply microvascular free flap tissue transfer in areas lacking recipient vessels and in which no other reconstructive options exists. No statistical differences in complications and overall outcome were found between immediate or secondary free tissue transfer. Meticulous monitoring of microvascular perfusion, however, is mandatory in both approaches and early intervention is necessary to ensure successful tissue transfer.

A combined anterolateral thigh flap and vascularized iliac crest flap in the reconstruction of extended composite defects of the anterior mandible

The technique of lower anterior facial reconstruction using a combination of an anterolateral thigh flap (ALTF) and a microvascular iliac crest flap is described and the results of 18 cases are reported. Eleven patients suffered recurrence after surgery and radiotherapy of oral squamous cell carcinoma of the lower face. These patients underwent a second surgery and reconstruction. In seven patients reconstruction was performed during primary surgical therapy, followed by postoperative radiotherapy. The pedicle of the ALTF was used for elongation of the iliac crest pedicle. There were no problems with the pedicle length and anastomoses even in patients who had received previous surgery and irradiation of the neck. There was no flap loss. There were no severe postoperative complications. One patient had distant metastases 18 months postoperatively. In all other patients there was no tumour recurrence or metastasis within 10-43 months of follow-up. The ALTF and vascularized iliac bone flap combination is useful in reconstruction of the lower face. The main advantage is the elongation of the iliac flap pedicle by the ALTF pedicle in patients with previous surgery in the neck.