63 - Freie Mitteilung
16. Mai 2019, 13:45 - 15:15, Sopra Grande, 4. OG
Temporary arteriovenous loop vein grafts for free flap transfer in patients with arteriosclerotic or injured recipient vessels and extensive lower limb tissue defects
A. Murtaja, M. Tremp, D. Kalbermatten, L. Gürke, T. Wolff, Presenter: A. Murtaja (Basel)
Free tissue transfer is a powerful tool to cover lower limb tissue defects in patients that would otherwise require major amputation. Frequently local recipient vessels are not suitable for the anastomosis of a free flap, either because of atherosclerotic disease or trauma. Long vein interposition grafts increase the failure rate of free flaps. Temporary loop vein grafts providing a low-resistance, high-flow shunt, divided at the time of free flap anastomosis, either in a one-stage or two-stage procedure may improve the success rate.
Retrospective study of consecutive patients.
Nine patients (7 men, 2 women) had a temporary arteriovenous vein loop placed and had free flap transfer to cover chronic lower limb ulcerations. In all of them arteriosclerosis of the popliteal or tibial artery was the indication for loop placement. The inflow artery was the below the knee popliteal artery in 5 patients, the distal superficial femoral artery in 1 patients, the above then knee popliteal artery in 1 patient and a tibial artery in 2 patients. The outflow vein was a popliteal vein in 6 patients and a tibial vein in 2 patients .In 8 patients the greater saphenous vein was used, in 1 patient the lesser saphenous vein. Median loop length was 30cm (min12, max 50cm). Median delay between the loop placement and free flap transfer was 15days. In 2 patients loop placement and free flap transfer were performed during the same procedure. In 7 patients a gracilis flap and in 2 patients a latissimus dorsi flap was used. Two patients had a loss of their flap and required consecutive major amputation, one of them was the patient with a loop length of 50cm. One patient died one week after surgery because of pneumonia.
Temporary arteriovenous loops make it feasible to cover soft tissue defects with free flaps in patients with otherwise unsuitable recipient vessels. We achieved a high rate of complete wound healing and a low rate of major amputation. The optimum length of the interval between loop placement and free flap transfer remains to be established. Good collaboration between vascular and plastic surgeons are required for these procedures as they combine surgical techniques and expertise from the two fields.