Free tissue transfer using bidirectional recipient veins in traumatic extremity reconstruction

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Reconstructive Surgery

Background:

• Reverse-flow flaps utilize retrograde flow for drainage, proving effective in reconstructive surgery.
• Limited research exists on reverse-flow recipient veins, prompting this investigation.
• The study explores bidirectional venous anastomoses for optimized venous outflow in traumatic extremity reconstruction.

Observation:

• A retrospective analysis of 188 patients with traumatic extremity free flaps compared antegrade and bidirectional venous anastomosis groups.
• Data analyzed included demographics, flap type, timing, recipient vessels, outcomes, and complications.
• Propensity score matching was employed for further analysis.

Findings:

• The bidirectional group (63 flaps) showed a significantly higher success rate (98.4%) and lower complication rate (6.3%) compared to the antegrade group (125 flaps; 89.7% success, 22.4% complications).
• Initial analysis indicated superior outcomes for bidirectional venous anastomoses, though these differences diminished after propensity score matching.
• Radial artery superficial palmar branch perforator flaps were most common in the bidirectional group, while thoracodorsal artery perforator flaps were most common in the antegrade group.

Implications:

• Bidirectional venous anastomoses using reverse flow are effective in reconstructive surgery.
• This technique provides a viable option for augmenting venous drainage in distal extremity reconstruction.
• It is particularly useful when additional antegrade venous dissection is challenging or not feasible.