The Effect Comparision Between End-to-end And End-to-side Small Blood Vessels Anastomosis On Free Flap Transplant Repairing Calf And Ankle Soft Tissue Defect

ObjectiveThrough retrospectively analyze the two groups of patients with calf and ankle skin and soft tissue defects by using the free flap transplant.The two groups were treated with end-to-end or end-to-side vascular anastomosis.The single-vessel anastomosis time,the Incidence of arterial crisis,the Incidence of venous crisis,the flap necrosis rate due to arterial crisis and the cold sensation of the affected limbs were observed and compared between the two groups.For the choice of vascular anastomosis to provide a reference.MethodsA review of 227 cases of free flaps(including latissimus dorsi muscle flap,anterolateral femoral flap)were used to repair calf and ankle soft tissue defects.Surgery was conducted from March 2010 to June 2015 at the First People's Hospital of Chenzhou Burn and Plastic Surgery.Of which 92 patients with end-to-end anastomosis,135 cases with end-to-side anastomosis.Patients aged 16-65 years,excluding other organic diseases,especially limb blood vessels have previous injuries,cases of blood system diseases,Among them,133 cases of car accident trauma,burns(thermal burns,electric injuries)in 54 cases,orthopedic postoperative infection in 40 cases of bone or bon tendon exposed.To observe the time of anastomosis of single artery,the Incidence of arterial crisis,Incidence of venous crisis,the flap necrosis rate due to arterial crisis.Follow up for six month to two year,Observe the bilateral foot temperature difference,cold numbness.Statistical analysis was used to compare the differences between the two groups.ResultsThere were 2 cases of arterial crisis and 3 cases of venous crisis,and 1 case of flap necrosis occurred by arterial crisis in end-to-end group.There were 1cases of arterial crisis and4 cases of venous crisis,and 1 case of flap necrosis occurred by arterial crisis in end-to-side group.37 cases were lost follow up in all cases.In end-to-end group 56 limbs have a sense of cold and bilateral foot temperature abnormalities in 50 cases.In the end-to-side group,there are 19 patient's limb has a cold feeling,15 patients with bilateral foot temperature difference.There was no statistically significant difference between the two groups in the time of single artery anastomosis,the incidence of arterial crisis,the incidence of venous crisis and the flap necrosis rate due to arterial crisis(P> 0.05).The difference between bilateral foot temperature,limb sensation was statistically significant(P <0.05).ConclusionIn the case of free flap repairing the calf and ankle skin and soft tissue defects,the end-to-side anastomosis does not damage the main blood vessels by the area,Can reduce the postoperative cold numbness and bilateral foot temperature difference between the incidence of abnormal,reduce the postoperative limb discomfort,is a worthy of promotion of the manual suture anastomosis.