Basic versus Complex Arteriovenous Loop Positions in Reconstructive Free Flap Surgery: An Outcome Analysis Focusing...

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Reconstructive Surgery

Background:

• Free flap reconstruction with an arteriovenous (AV) loop is a high-risk procedure for select patients.
• Factors influencing complications like thromboembolic events and flap failure require further clarification.

Purpose of the Study:

• To investigate the influence of AV loop positioning complexity, defect localization, and antithrombotic regimens on postoperative outcomes in free flap reconstruction.

Main Methods:

• Retrospective review of 123 patient records from 2003-2023.
• Comparison of outcomes based on AV loop positioning complexity, reconstruction stage, defect location, flap type, and antithrombotic strategy.

Main Results:

• Loop thrombosis and failure rates varied significantly by defect site.
• Flap failure rates were higher with complex AV loop positioning (17%) compared to basic (3%).
• Antithrombotic regimens differed significantly based on loop complexity, with combined low-dose heparin and aspirin associated with higher thrombosis in complex loops.

Conclusions:

• Defect localization and AV loop positioning complexity are critical determinants of vascular thrombosis and flap failure.
• Personalized antithrombotic strategies are essential for optimizing outcomes in AV loop-assisted free flap reconstructions.