ROLE OF ARTERIOVENOUS VASCULAR LOOPS IN MICROSURGICAL RECONSTRUCTION OF THE EXTREMITIESABSTRACT
Objective: To analyze 10 consecutive cases of microsurgical arteriovenous loops created to reconstruct complex injuries from March 2011 to May 2012.
Methods: This observational cohort-type study conducted by the Hand and Microsurgery Group at the HC-FMUSP included patients who were candidates for microsurgical reconstruction as a last alternative to amputation of the limb with proven absence of adequate recipient vessels for primary microsurgical anastomosis, in a prospective and consecutive manner. We analyzed 14 variables (epidemiological, clinical, procedure-related, and outcome) in patients who underwent reconstruction using an arteriovenous loop utilizing a single-stage or two-stage procedure.
Results: The injuries were mostly traumatic (80%). The success rate of the single-stage procedure was 75%, and 17% for the two-stage procedure. The rate of preservation for the injured limb was 44%.
Conclusion: This study reinforces the more recent understanding that the indication for single-stage or two-stage reconstruction should be individualized; our findings favor the single-stage reconstruction. This technique should be used in selected cases, as a last reconstructive alternative before amputation, and further studies are necessary to confirm its safety and efficacy in our practice. Level of Evidence IV; Case series.
Keywords:
Arteriovenous fistula; Microsurgery; Upper extremity; Lower extremity.
Severe trauma in lower left leg. Angiotomography showed only the posterior tibial artery was patent. Latissimus dorsi flap used to cover the leg injury, rebuilt with vascular loop created in two-stage procedure. Arrow: Vascular loop constructed 2 days prior to coverage with the flap. Right: 12 months after surgery, patient walking normally.
Traumatic amputation of the right forearm. Vessels in good condition were identified in the amputated portion, but receiving vessels in the arm were not suitable for anastomosis. Construction of an arteriovenous loop with the ipsilateral saphenous vein for ectopic reimplantation of the amputated limb. Arrow: Microsurgical vascular loop. Finalized ectopic reimplantation, with good perfusion.