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SERBEST FLEP İLE BAŞ BOYUN REKONSTRÜKSİYONLARINDA MİKROVASKÜLER BİRLEŞTİRİCİ KULLANIMI: KLİNİK DENEYİMLERİMİZ

Year 2014, Volume: 15 Issue: 1, 17 - 20, 01.04.2014

Abstract

AMAÇ: Mikrovasküler anastomoz serbest doku aktarımı ve replantasyon operasyonlarının temel basamağını teşkil eder. Mikrovasküler ven anastomozu, arter anastomozuna göre teknik olarak zordur. Basit sütürle uygulanan geleneksel mikrovasküler anastomoz iyi bilinen ve başarılı bir tekniktir. Bununla birlikte zaman alıcıdır ve uygulaması üst düzey cerrahi deneyim gerektir. Serbest flep operasyonlarının en önemli major başarısızlık nedeni halen erken ve geç venöz tromboz oluşumudur. Mikrovasküler birleştiriciler 10 yılı aşkın süredir özellikle venöz anastomozlarda klinik kullanımdadır. Ancak özellikle son dönemlerde mikrocerrahlar arasında mikrovasküler birleştirici kullanımı popülerlik kazanmıştır.GEREÇ ve YÖNTEM: Bu çalışmada ven anastomozunu kolaylaştırmak amacıyla, kliniğimizde mikrovasküler birleştirici kullanım deneyimlerimiz sunulmuştur. Tekniğin detayları tarif edilmiştir. Sonuçlar ve postoperatif komplikasyon oranları değerlendirilmiş ve tekniğin avantaj ve dezavantajları tartışılmıştır. BULGULAR: Kliniğimizde 2013-2014 yılları arasında opere edilmiş 9 hastada, toplam 12 adet anastomozda 2, 2,5 ve 3 mm çaplı birleştiriciler kullanılmıştır. Postoperatif dönemde hiçbir hastada venöz tromboz gelişmemiştir. Bir hastada arteriyel tromboza bağlı total flep kaybı gelişmiştir.SONUÇ: Mikrovasküler birleştirici, serbest flep operasyonlarında venöz anastomozlarda kullanımı kolay, sonuçları başarılı ve gelecekte çok daha sıklıkla kullanılacağını düşündüğümüz bir aparattır

References

  • 1. Ardehali B, Morritt AN, Jain A. Systematic review: Anastomotic microvascular device. J Plast Reconstr Aesthet Surg 2014;67(6):752-5.
  • 2. Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. Can J Plast Surg 2012,20:98-102.
  • 3. Lin TS, Chiang YC. Combined microvascular anastomosis: experimental and clinical experience. Ann Plast Surg 2000;45:280-3.
  • 4. Turan T, Ozcelik D, Kuran I, Sadikoglu B, Bas L, San T, Sungun A. Eversion with four sutures: an easy, fast, and reliable technique for microvascular anastomosis. Plast Reconstr Surg 2001;107:463-70.
  • 5. Zeebregts C, Acosta R, Bölander L, van Schilfgaarde R, Jakobsson O. Clinical experience with nonpenetrating vascular clips in free-flap reconstructions. Br J Plast Surg 2002;55:10-110.
  • 6. Ostrup LT. Anastomosis of small veins with suture or Nakayama's apparatus: A comparative study. Scand J Plast Reconstr Surg 1976;10:9-17.
  • 7. Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010;125:792-8.
  • 8. Cope C, Ng R, Miller M, Langstein H. Technique and clinical experience of the unilink/3M® microvascular anastomotic coupling device in free flap surgery. The Internet Journal of Plastic Surgery 2001;1
  • 9. Moskovitz MJ, Bass L, Zhang L, Siebert JW. Microvascular anastomoses utilizing new intravascular stents. Ann Plast Surg 1994;32:612-8.
  • 10. Yap LH, Constantinides J, Butler CE. Venous t h r omb o sis i n c o u p l e d v e rs u s s u t u r e d microvascularanastomoses. Ann Plast Surg 2006;57:666-9.

Use of Microvascular Coupler in Head and Neck Reconstruction with Free Flaps: Our Clinical Experience

Year 2014, Volume: 15 Issue: 1, 17 - 20, 01.04.2014

Abstract

Objective: Microvascular anastomosis is the primary step in free flap and replantation operations. Microvascular venous anastomosis is technically more challenging than arterial anastomosis. The traditional simple hand sewn anastomosis is a well known and successfully technique but it is time consuming and much surgical experience is needed for successfully outcomes. Still today the most important major flap failure reason is venous thrombosis. Microvascular couplers which are use generally for venous anastomosis have been used more than a decade but recently couplers gained more popularity among microsurgeons. Materials and Methods: In this study, we present our experience with microvascular coupler usage to facialite venous anostomosis in frre flap surgery. We describe the details of the technique. Results, post operative complication rates and advantages and disadvantages of couplers are discussed. Results: 2, 2,5 and 3 mm diameter 12 microvascular couplers were used in nine patients between 2013and 2014. No venous anaostomosis occurred in the post operative period. One total flap failure occured due to arterial thrombosis. Conclusion: Microvascular couplers are useful tools that are used in venous anastomosis in free flap operations which are easy to use, have high success rates and we believe that in the future they will be used much more frequently.

References

  • 1. Ardehali B, Morritt AN, Jain A. Systematic review: Anastomotic microvascular device. J Plast Reconstr Aesthet Surg 2014;67(6):752-5.
  • 2. Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. Can J Plast Surg 2012,20:98-102.
  • 3. Lin TS, Chiang YC. Combined microvascular anastomosis: experimental and clinical experience. Ann Plast Surg 2000;45:280-3.
  • 4. Turan T, Ozcelik D, Kuran I, Sadikoglu B, Bas L, San T, Sungun A. Eversion with four sutures: an easy, fast, and reliable technique for microvascular anastomosis. Plast Reconstr Surg 2001;107:463-70.
  • 5. Zeebregts C, Acosta R, Bölander L, van Schilfgaarde R, Jakobsson O. Clinical experience with nonpenetrating vascular clips in free-flap reconstructions. Br J Plast Surg 2002;55:10-110.
  • 6. Ostrup LT. Anastomosis of small veins with suture or Nakayama's apparatus: A comparative study. Scand J Plast Reconstr Surg 1976;10:9-17.
  • 7. Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010;125:792-8.
  • 8. Cope C, Ng R, Miller M, Langstein H. Technique and clinical experience of the unilink/3M® microvascular anastomotic coupling device in free flap surgery. The Internet Journal of Plastic Surgery 2001;1
  • 9. Moskovitz MJ, Bass L, Zhang L, Siebert JW. Microvascular anastomoses utilizing new intravascular stents. Ann Plast Surg 1994;32:612-8.
  • 10. Yap LH, Constantinides J, Butler CE. Venous t h r omb o sis i n c o u p l e d v e rs u s s u t u r e d microvascularanastomoses. Ann Plast Surg 2006;57:666-9.
There are 10 citations in total.

Details

Other ID JA88TD96SC
Journal Section Research Article
Authors

Saime İrkören This is me

Heval Selman Özkan This is me

Ender Ceylan This is me

Hüray Karaca This is me

Publication Date April 1, 2014
Published in Issue Year 2014 Volume: 15 Issue: 1

Cite

EndNote İrkören S, Özkan HS, Ceylan E, Karaca H (April 1, 2014) Use of Microvascular Coupler in Head and Neck Reconstruction with Free Flaps: Our Clinical Experience. Meandros Medical And Dental Journal 15 1 17–20.