Thrombose genähter vs. gekoppelter Anastomosen bei mikrovaskulären Kopf- und Halsrekonstruktionen

Zusammenfassung

Hintergrund Die Kupplungsvorrichtung für mikrovaskuläre Anastomosen hat in der freien Gewebetransplantation weite Verbreitung gefunden. Ziel der Arbeit ist der Vergleich der Thromboserate und des Transplantatversagens in Abhängigkeit von der Anastomosentechnik an einem großen Kopf-Hals-Tumorzentrum.

Material und Methoden Retrospektive Auswertung von allen Patienten, die im Zeitraum von 2001–2019 eine freie Lappenrekonstruktion erhalten haben. Rekonstruktionstyp, Empfängergefäße, Anzahl an Venenanastomosen, Coupler-Größe und Operationszeit wurden untersucht. Wir verglichen die Raten an Venenthrombosen zwischen handgenähten und gekoppelten Anastomosen sowie die Rate des Transplantatversagens.

Ergebnisse Insgesamt wurden 403 freie Lappenrekonstruktionen über einen Zeitraum von 17 Jahren durchgeführt. Die venöse Anastomose wurde bei 113 Lappen in Einzelknopftechnik genäht und in 290 Fällen mittels Coupler durchgeführt. Die Rate der Venenthrombosen, die eine umgehende chirurgische Revision erforderten, betrug in der genähten Gruppe 6,2 % (7/113), verglichen mit 7,6 % in der gekoppelten Gruppe (22/290; p = 0,627). Bei einer allgemeinen Erfolgsrate von 95,0 % (383/403) lag die Rate des Transplantatversagens jeweils bei 3,6 % (4/113) und 5,5 % (16/290; p = 0,421). Die Operationszeit war mit 680 ± 144 Minuten in der handgenähten Gruppe und 688 ± 167 Minuten in der Coupler-Gruppe vergleichbar (p = 0,678).

Schlussfolgerungen Bei ähnlichen Erfolgsraten ist der Coupler als wirksame Alternative zur venösen Anastomose in Einzelnahttechnik zu sehen. Aufgrund der allgemein niedrigen Rate an Stielthrombosen in beiden Gruppen können wir den Einfluss der Anastomosentechnik nicht von möglichen Störvariablen trennen.

Abstract

Objective The Anastomotic Coupling Device for microvascular anastomoses has become widely used in free tissue transplantation. This study compares the thrombosis rate and flap failure as a function of the anastomosis technique at a large head and neck cancer center.

Material and Methods Retrospective analysis of all patients receiving free flap reconstructions in the period 2001–2019. Reconstruction type, recipient vessels, number of venous anastomoses, coupler size, and operation time were investigated. We compared the rates of venous thrombosis between hand sewn and coupled anastomoses, as well as the rate of flap failure.

Results A total of 403 free flap reconstructions were performed for over 17 years. The venous anastomosis was sewn in 113 flaps in single suture technique, and in 290 cases, coupler device was used. The rate of venous thrombosis requiring immediate surgical revision was 6.2 % (7/113) in the sewn group compared to 7.6 % in the coupled group (22/290; p = 0.627). With an overall success rate of 95.0 % (383/403), the rate of flap failure was 3.6 % (4/113) and 5.5 % (16/290; p = 0.421), respectively. Surgical time is comparable with 680 ± 144 minutes in the hand-sewn group and 688 ± 167 minutes in the coupled group (p = 0.678).

Conclusions With similar success rates, the coupler device is an effective alternative to venous anastomosis in single suture technique. Due to the generally low rate of pedicle thrombosis in both groups, we cannot separate the influence of the anastomosis technique from possible interfering variables.

Schlüsselwörter

Stielthrombose - Venenanastomose - Anastomotic Coupling Device - freie Lappenplastiken - Transplantatversagen

Key words

pedicle thrombosis - venous anastomosis - anastomotic coupling device - free flap reconstruction - flap failure

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