Título / Title

Do two venous anastomoses decrease complications of limb reconstructions with the anterolateral thigh flap?

Introdução / Introdution

A major concern when performing free flaps for limbs soft tissue reconstruction lies in selecting proper recipient artery and veins, as those are frequently affected by indirect lesion after initial high-energy trauma or subsequent scarring. Choosing between recipient veins from the superficial or deep venous system or whether one or two venous anastomosis should be performed are important decisions in limbs soft tissue reconstruction, as venous thrombosis is one of the most common recorded complications

Objetivo / Purpose

The questions of how many veins should be reconnected after free flap surgery for limb reconstruction, and how it influences the results, are still object of controversy throughout medical literature. In this report, results of one versus two venous anastomoses for anterolateral thigh flaps in limb reconstruction were evaluated

Material e Método / Material and Methods

Perioperative information was recorded and patients were divided in two groups according to number of venous anastomosis: group 1 (one venous anastomosis; 17 patients) and group 2 (two venous anastomosis; 21 patients)

Resultados / Results

Complications were more common in group 1, with a 47% complication rate, versus 24% in group 2 (not statistically significant, p=0,065). No risk factor for complications or total flap loss was identified. Revision of the anastomosis was performed in 5 patients (4 cases of group 1) resulting in three flap salvages. The overall success rate was 92% after ALT flaps for limb reconstruction following extensive wounds that could not be managed with local flaps

Discussão / Discussion

In regard to limb reconstruction, our study and Heidekrueger et al15 could not demonstrate difference in results with two venous anastomoses in 201 ALT flaps, for lower extremity reconstruction, but observed an operatory time longer with two venous anastomosis (p<0,05). In our study, the mean intraoperative ischemia time of ALT free flap was not significantly higher in two veins anastomosis group, which can be justified by intraoperative technical difficulties, leading to difficult situations when only one venous anastomosis is possible, such as, position or distance of microanastomosis and absence of suitable recipient veins at limbs after high-energy trauma with damage of veins from superficial or deep venous system

Conclusão / Conclusion

Two venous anastomoses for ALT free flaps in limb reconstruction resulted in a lower absolute rate of complications, albeit the difference between groups was not statistically significant.

Palavras Chave / Keywork

Free tissue flaps, Postoperative complications; Microsurgery; Microvascular anastomosis