Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls.

Publication ,  Journal Article
Langdell, HC; Shammas, RL; Atia, A; Chang, EI; Matros, E; Phillips, BT
Published in: Plast Reconstr Surg
March 1, 2022

Vein grafts enable soft-tissue reconstruction in cases of insufficient pedicle length, a lack of nearby recipient vessels, and a wide zone of injury caused by trauma or radiation therapy. The purpose of this article is to provide a comprehensive review of vein grafts in free flap reconstruction focusing on the timing of arteriovenous loops, complications, and surgical technique. Vein graft indications, types of vein grafts, and location-specific considerations are also reviewed. Three reconstructive microsurgeons at high-volume centers were asked to offer institutional pearls on the order of anastomosis, selection of donor veins, and timing of arteriovenous loops. In terms of gap length, vessel gaps less than 10 cm may be reconstructed with an interposition or transposition vein graft. For longer gaps, surgeons should consider the use of arteriovenous loops, transposition arteriovenous loops, or flow-through flaps. Both one and two-stage arteriovenous loops are used, depending on patient comorbidities, potential exposure of critical structures, and surgeon preference. Although one-stage arteriovenous loops expedite the reconstructive process, two-stage arteriovenous loops require shorter operations and help identify patients at risk of flap failure. Although whether the use of vein grafts increases flap failure rates is controversial, complications are highest in lower extremity reconstruction, cases of a prolonged interval between stages in two-stage arteriovenous loops, and unplanned vein grafts.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

March 1, 2022

Volume

149

Issue

3

Start / End Page

742 / 749

Location

United States

Related Subject Headings

  • Veins
  • Surgery
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Microsurgery
  • Humans
  • Free Tissue Flaps
  • 3203 Dentistry
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Langdell, H. C., Shammas, R. L., Atia, A., Chang, E. I., Matros, E., & Phillips, B. T. (2022). Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls. Plast Reconstr Surg, 149(3), 742–749. https://doi.org/10.1097/PRS.0000000000008856
Langdell, Hannah C., Ronnie L. Shammas, Andrew Atia, Edward I. Chang, Evan Matros, and Brett T. Phillips. “Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls.Plast Reconstr Surg 149, no. 3 (March 1, 2022): 742–49. https://doi.org/10.1097/PRS.0000000000008856.
Langdell HC, Shammas RL, Atia A, Chang EI, Matros E, Phillips BT. Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls. Plast Reconstr Surg. 2022 Mar 1;149(3):742–9.
Langdell, Hannah C., et al. “Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls.Plast Reconstr Surg, vol. 149, no. 3, Mar. 2022, pp. 742–49. Pubmed, doi:10.1097/PRS.0000000000008856.
Langdell HC, Shammas RL, Atia A, Chang EI, Matros E, Phillips BT. Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls. Plast Reconstr Surg. 2022 Mar 1;149(3):742–749.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

March 1, 2022

Volume

149

Issue

3

Start / End Page

742 / 749

Location

United States

Related Subject Headings

  • Veins
  • Surgery
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Microsurgery
  • Humans
  • Free Tissue Flaps
  • 3203 Dentistry
  • 3202 Clinical sciences
  • 1103 Clinical Sciences