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J Reconstr Microsurg 2024; 40(07): 535-541
DOI: 10.1055/a-2240-1534
Original Article

Comparisons of Impact of Vein Grafting with Different Indications on Outcomes of Reconstruction with Free Flaps

Michelle Coriddi   *
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Leslie Kim    *
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Kathryn Haglich
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Jonas Nelson
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Farooq Shahzad
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Joseph Dayan
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Joseph Disa
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Babak Mehrara
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Peter Cordeiro
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Colleen McCarthy
1   Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
› Author Affiliations Funding This research was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748, which supports Memorial Sloan Kettering Cancer Center's research infrastructure.
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Abstract

Background Prior studies have shown an increased risk of complications and flap loss with the use of vein grafts in microsurgery. We hypothesize that indication for use of a vein graft can affect flap complications and loss rates.

Methods We performed a retrospective review of all patients at our institution from 2010 to 2020 who underwent free flap reconstruction and required use of a vein graft. Indications for vein grafting included: salvage of flap during primary operation after microvascular compromise, augmentation of flow during primary operation, lengthening of the flap pedicle during the primary operation, and salvage of the flap during a secondary salvage operation after microvascular compromise.

Results A total of 79 patients met the study inclusion criteria. There were significant differences among the vein graft indication groups and the following: area of reconstruction (p = 0.002), vein graft length (p = 0.018), vessels grafted (p = 0.001), vein graft donor site (p = 0.011), and total flap loss (p = 0.047). Of the four indications for vein grafting, salvage of the flap during secondary salvage operation after microvascular compromise had the highest rate of total flap loss (26.7%). There were no significant associations between other flap complications and vein graft indications.

Conclusion Vein graft use in the primary reconstructive setting is efficacious, with low risk of thrombosis. Use in secondary procedures, however, is associated with higher rates of total flap loss, likely due to the thrombotic process, which was initiated prior to the use of the graft resulting in the salvage procedure and not secondary to the graft itself.

Keywords

vein graft - microvascular reconstruction

Notes

B.M. is an advisor to PureTech Corp and the recipient of an investigator-initiated research award from Regeneron Corp. J.H.D. is an advisor to Stryker Corporation, is on the board of Welwaze Medical LLC and has a royalty agreement with Springer Publishers for the book: Multimodal Treatment of Upper and Lower Extremity Lymphedema.


* Coriddi and Kim served as co-first authors.




Publication History

Received: 26 June 2023

Accepted: 05 January 2024

Accepted Manuscript online:
08 January 2024

Article published online:
16 February 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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