• Jonas A Nelson, John P Fischer, Ritwik Grover, Stephen J Kovach, David W Low, Suhail K Kanchwala, L Scott Levin, Joseph M Serletti, and Liza C Wu.
• Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jonas.nelson@uphs.upenn.edu.
• J Plast Reconstr Aesthet Surg. 2015 Jun 1; 68 (6): 830-6.

IntroductionThere is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique.MethodsAll microsurgical cases at a single institution from 2005 to 2011 were examined for use of IVGs in the primary procedure or during take back or salvage attempts. We examined the cohort overall and performed a subgroup analysis by timing of initial IVG.ResultsIn the study period, 1718 patients underwent 2368 free flaps. 51 IVGs were utilized in 38 patients (2.2%) and 38 flaps (1.6%). Eight (42.1%) of the primary procedure IVGs (n = 19) were planned preoperatively. Nine total flap losses (24%) occurred when IVGs were utilized, 89% of which occurred in the take back cohort (p = 0.02). However, planned IVG had a 100% success rate, and IVG utilized in the primary procedure overall had a 95% success rate. Importantly, A significantly higher rate of thrombotic events was noted in all primary cases where IVGs were utilized (p = 0.005).ConclusionsThis study demonstrates that IVGs can be utilized in primary free flap reconstructions with success rates exceeding 95%. However, in salvage procedures, the use of vein grafts does not approach the same rate of success likely due to multiple factors. Yet when utilized appropriately with thrombectomy and resection of the thrombosed vessel to healthy intima, IVGs can provide an important tool for flap salvage.Level Of Evidenceprognostic/risk category, level II.Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

42 keywords...

hide…