Bridging the gap: A 20-year experience with vein grafts for free flap reconstruction, the odds for success

BACKGROUND: Successful free tissue transfer requires tension-free microvascular anastomoses. Vein grafts are utilized when this cannot be obtained, which increases microsurgical complexity and the chance of vessel thrombosis. Previous studies on vein grafts are limited to low numbers and selected techniques, making it difficult to draw conclusions. METHODS: A retrospective chart review was performed for all patients who underwent vein grafts in free flap reconstruction from 1995 to 2015. Information on patient and flap characteristics, as well as returns to the operating room and flap loss were analyzed. RESULTS: Seventy-two free flap reconstructions requiring 122 vein grafts were performed. The majority were performed in the initial operation (82%) and of those, the majority were planned (71%). Reconstruction was most often in the genitourinary/perineal (49%) and head and neck (38%) regions. The most common vein graft types utilized were transposition arteriovenous (AV) loops (57%) and interpositions (26%). Of the initial cases, 22% returned to the operating room resulting in a 7% total and 7% partial flap loss rate. On univariate analysis, graft timing/planning, gap type, vein graft type, and reconstruction location were significantly associated with take-backs and flap loss. However, gap type and location seem to be strongly associated with graft timing/planning and vein graft type. Graft type and planning/timing don't have as strong a relationship and seem to independently relate to flap loss. CONCLUSIONS: Vein grafts are more successful when planned and when performing transpositions and AV loops over interpositions. These graft types should be considered over interpositions when possible. Presented at ASRM annual meeting 2017, Hawaii. Clinical Trial Registration: Not applicable. IRB Approval: This study was approved by the Institutional Review Board at The University of Chicago in Chicago, Illinois. Funding Source: No external funding was secured for this study. Products Used in Manuscript: None Corresponding Author: Amir Inbal MD, Section of Plastic and Reconstructive Surgery, University of Chicago, 5841 S. Maryland Avenue, MC 6035, Chicago, IL 60637, Email: amirkormaninbal@gmail.com, Mobile: +972 54 7500522 ©2018American Society of Plastic Surgeons

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