Comparative Study of Two Types of Vein Graft Application in Microvascular Head and Neck Reconstruction

頭頸部顯微皮瓣重建使用兩種靜脈移植方法之比較

Ming-Hsien Chung(鍾明憲) ； Chih-Sheng Lai(賴志昇) ； Chieh-Kai Chang(張捷凱) ； Cheng-Yeu Wu(吳鎮宇) ； Yi-Ling Lin(林奕伶) ； Yueh-Chi Tsai(蔡岳錤) ； Chen-Te Lu(呂俊德) ； Jung-Hsing Yen(顏榮信) ； I-Chen Chen(陳伊呈)

《臺灣整形外科醫學會雜誌》 32卷1期 (2023/03) Pp. 49-62

摘要

Background: Vein graft has been used in head and neck microvascular free flap reconstruction for certain cases with either the single interposition conduit or arteriovenous (AV) loop technique. Aims and Objectives: This study compared the indications and outcomes between these two methods of vein graft technique. Materials and Methods: A retrospective review was performed, and 64 free flaps in head and neck reconstruction with vein grafting from 2013 to 2021 were enrolled and divided into AV loop group and single conduit group. Data regarding patient demographics; surgical indications; history of prior free flap, prior neck dissection, radiation therapy, and chemotherapy; and type of flap, recipient vessels, specific vein graft application, and flap outcomes were collected and analyzed. Results: The AV loop method was performed in 47 flaps, and the single conduit method was used in 17 flaps, which included 4 cases of arterial conduit and 13 cases of venous conduit. The proportion of flap compromise and flap loss in the AV loop group was 17% and 12.8%, respectively, versus 5.9% and 5.9%, respectively, in the single conduit group. No statistically significant difference was observed between the two groups (p = 0.424 and p = 0.664). Conclusion: The AV loop technique and single conduit method are both useful for head and neck free flap reconstruction in vessel-depleted neck. However, the risk of flap failure was potentially higher for AV loop and it should be carefully used.

關鍵字

vein graft ； AV loop ； head and neck reconstruction

並列摘要

背景：在特定情況下，靜脈移植可以被應用於頭頸部之顯微皮瓣重建中，其中使用方式可分為單一血管架接，或是暫時性動靜脈迴路（AV loop）。目的及目標：此篇文章旨在研究兩者不同方法之比較。材料及方法：此篇為一回朔性研究，自2013至2021年，共收集了64人次之顯微皮瓣合併靜脈移植手術，並且分為動靜脈迴路及單一血管架接兩組。收集並分析了病人之基本資料、手術適應症、過去病史、皮瓣種類、使用之血管、靜脈移植方式，以及手術結果。結果：共有47檯皮瓣手術使用暫時性動靜脈迴路，而17檯皮瓣手術使用單一血管架接。動靜脈迴路組之皮瓣失敗率為12.8%，而單一血管架接組為5.9%。兩者之差異在統計學上未達顯著意義（p=0.664）。結論：在頸部血管選擇較少之頭頸部重建時，需避免使用靜脈移植，若仍然需要時，暫時性動靜脈迴路或是單一血管架接之靜脈移植皆為實用之方法，但暫時性動靜脈迴路有潛在較高的風險，更需謹慎使用。