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Efficacy of the microscopic parachute end-to-side technique for creating large-to-small venous anastomoses in free flaps in the extremities
Title: | Efficacy of the microscopic parachute end-to-side technique for creating large-to-small venous anastomoses in free flaps in the extremities |
Authors: | Motomiya, Makoto Browse this author | Watanabe, Naoya Browse this author | Ota, Mitsutoshi Browse this author | Shimoda, Kohei Browse this author | Kawamura, Daisuke Browse this author | Iwasaki, Norimasa Browse this author →KAKEN DB |
Keywords: | End-to-side anastomosis | Free flap | Microscopic parachute end-to-side (MPETS) | anastomosis | Parachute | Venous anastomosis | Venous valve |
Issue Date: | Dec-2022 |
Publisher: | Elsevier |
Journal Title: | JPRAS Open |
Volume: | 34 |
Start Page: | 189 |
End Page: | 198 |
Publisher DOI: | 10.1016/j.jpra.2022.10.003 |
Abstract: | Purpose: The availability of reliable and suitably sized veins is limited for creating free flaps to treat severe trauma and infection, and it is important to manage vessel size discrepancy between the recipient and flap veins. We evaluated the clinical outcomes of free flaps with large-to-small venous end-to-side (ETS) anastomoses using the microscopic parachute end-to-side (MPETS) anastomosis in soft tissue defects in the extremities. This procedure comprises mainly a wide-slit venotomy and parachute procedure at the heel. Methods: We examined 24 free flaps in 23 patients given a largeto-small venous anastomosis using the MPETS technique. Patient demographics, details of vessel anastomoses, and flap outcomes and complications were obtained from medical records. Results: Two veins were anastomosed in six flaps. Thirty anastomosed veins were assessed, and 24 deep veins, all of which accompanied main arteries, were chosen as recipient veins. The mean diameters were 1.5 mm in the recipient veins and 2.7 mm in the flap veins, and the mean vessel size discrepancy was 1.8-fold (range 1.3-3.3 fold). Because of the presence of venous valves at the anastomotic site, trimming of venous cusps was performed in six veins. All flaps survived, though one venous thrombosis occurred because of pedicle kinking in a case with a short pedicle. Conclusions: The MPETS technique is simple, reliable, and useful for performing various types of venous anastomoses regardless of a vessel size discrepancy and the presence of a venous valve. This may be a good option for large-to-small venous anastomosis in free flaps. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. |
Type: | article |
URI: | http://hdl.handle.net/2115/88646 |
Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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