RESUMEN
Microsurgical subinguinal varicocelectomy (MSV) is the gold standard for treating varicoceles. Preservation of the internal spermatic arteries (ISAs) during MSV is important for sperm production. This study aimed to evaluate the safety and efficacy of elevating systolic blood pressure (SBP) using MSV. Data from 252 consecutive adult male patients were retrospectively reviewed. The patients were divided into two groups: a traditional group that underwent conventional MSV (n = 134) and a modified group that underwent MSV with a transiently elevated SBP of 140-160 mm Hg (n = 118). Arterial identification time, unilateral operative time, number of ISAs, arterial injury rate, and other postoperative indicators, including postoperative complications and sperm parameters, were compared between the groups. All the procedures were successful. The arterial identification and unilateral operative times were significantly shorter in the modified group (31.34 ± 10.44 vs. 42.94 ± 12.39 min and 61.48 ± 8.78 vs. 76.35 ± 12.33 min, p < .01, respectively). Intraoperatively, the number of preserved ISAs was significantly higher in the modified group (1.92 ± 0.53 vs. 1.45 ± 0.32, p < .01). The arterial injury rate did not differ significantly between the groups (2.74% vs. 0%, respectively). Compared with preoperative values, sperm parameters improved significantly 6 months postoperatively. Significant differences in semen parameters or postoperative complications were not observed between the groups. Elevated intraoperative SBP can be used to rapidly, safely, and effectively identify ISAs, increase the number of retained spermatic arteries, and markedly reduce the operative time for MSV.
Asunto(s)
Microcirugia , Varicocele , Humanos , Masculino , Varicocele/cirugía , Microcirugia/métodos , Adulto , Estudios Retrospectivos , Presión Sanguínea , Adulto Joven , Arterias/cirugía , Espermatozoides , Tempo OperativoRESUMEN
Patients with traumatic ischemic mangled extremities first undergo arterial reconstruction using autogenous vein grafts, followed by flap transplantation as a staged treatment for soft tissue reconstruction. This study aimed to report the outcomes of such a staged treatment. Thirteen patients underwent arterial reconstruction between February 2015 and April 2017 due to damage to the major blood vessels by the traumatic mangled extremities. Of them, 6 patients (5 males and 1 female with a mean age of 51 years, age range: 36-60 years) who underwent soft tissue reconstruction due to necrosis were retrospectively analyzed. The average Mangled Extremity Severity Score was 7.2 (range, 6-8). Injuries were found in the lower leg (4 cases), foot (1 case), and wrist and hand (1 case). Arterial reconstruction was performed using autologous venous grafts. The reconstructed arteries included the posterior tibial artery (3 cases), anterior tibial artery (1 case), dorsalis pedis artery (1 case), and radial artery (1 case). The blood circulation status of the reconstructed blood vessels was assessed using computed tomography angiography at an average of 5 weeks (range, 4-6 weeks) after arterial reconstruction. For some necrotic soft tissues, debridement and flap transplantation were performed an average of 7 weeks (range, 6-8 weeks) after arterial reconstruction. Soft tissue reconstruction was performed with an anterolateral thigh free flap in 4 cases, a local flap in 1 case, and a muscle flap in 1 case. In 5 out of 6 cases, blood circulation was maintained in the reconstructed blood vessels, resulting in the salvaging of the extremities. All the patients who underwent flap surgery survived. Notably, there were no special complications during a follow-up visit conducted at an average of 19 months post-reconstruction. To treat an ischemic mangled extremity, the limbs should first be salvaged with arterial reconstruction, followed by subsequent appropriate flap surgery when soft tissue necrosis occurs at the mangled site as a staged treatment.
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Isquemia , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Procedimientos de Cirugía Plástica/métodos , Isquemia/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Arterias/cirugía , Desbridamiento/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: The submental artery perforator flap (SMAPF) is an alternative to reconstruct oral and maxillofacial defects secondary to oral cancers. However, vascular anomalies or surgical damage often lead to vascular crises or harvest failure. Our clinical findings suggest that the vena comitans of the facial artery (cFA) very commonly exist. This study aimed to investigate the reliability of the cFA as a sole venous reflux route for the SMAPF. METHOD: The patients were from the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University. All patients were treated for oral cancer between January 2016 and September 2022. Seventeen SMAPFs were successfully raised to reconstruct the postoperative defects, of which 7 had cFA as the sole reflux route. RESULTS: The size of the flaps varied from 4.0×3.0 cm to 12.0×3.0 cm. All flaps survived. Patients were followed from 1 month to 5 years. Satisfactory restoration of contour and functional outcomes were achieved at the recipient sites. The scars were well camouflaged in the submental region. No local or regional recurrence was detected during follow-up. Patients had an overall 2-year survival rate of 100% with no suspected flaps-related recurrence. CONCLUSIONS: The cFA as the sole venous reflux route for SMAPF is reliable for flap harvesting and is applicable for immediate defect reconstruction secondary to cancer resection.
Asunto(s)
Cara , Neoplasias de la Boca , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Colgajo Perforante/irrigación sanguínea , Masculino , Femenino , Persona de Mediana Edad , Cara/irrigación sanguínea , Cara/cirugía , Adulto , Neoplasias de la Boca/cirugía , Procedimientos de Cirugía Plástica/métodos , Anciano , Arterias/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND Scaphoid nonunion (SN) is a challenging condition in wrist pathology, often resulting in severe consequences if left untreated. Surgical intervention, particularly using vascularized bone grafts (VBGs), is a promising but uncertain approach. The 4+5 extensor compartment artery (ECA) pedicled graft, less commonly used for SN, has potential benefits due to its vascular supply and accessibility to the scaphoid. This study aimed to evaluate the effectiveness of the 4+5 ECA pedicled graft combined with headless compression screw fixation in treating avascular necrosis (AVN)-induced proximal pole SN. Radiological results, functional outcomes, and complications related to this method were assessed. MATERIAL AND METHODS This was a retrospective analysis of 19 proximal pole SN cases with AVN treated using the 4+5 ECA-VBG technique from 2016 to 2022. Patients underwent preoperative evaluation and postoperative follow-up for at least 1 year. Data on surgery, demographics, radiological assessments, and functional outcomes were recorded and analyzed statistically. RESULTS All patients achieved radiographic union within 8.5 weeks postoperatively, with revascularization of proximal pole necrosis. Significant improvements in functional outcomes were observed, including pain reduction, increased wrist range of motion, improved grip and pinch strength, and enhanced wrist scores. No major complications were reported. CONCLUSIONS The 4+5 ECA-VBG technique, with headless compression screw fixation, showed high success rates in treating AVN-induced proximal pole SN. This method offers comprehensive restoration of wrist function and minimal complications, making it a viable option for SN management, especially in AVN cases. Further research is needed to confirm these results and establish standardized protocols for SN treatment.
Asunto(s)
Trasplante Óseo , Fracturas no Consolidadas , Osteonecrosis , Hueso Escafoides , Humanos , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Masculino , Estudios Retrospectivos , Femenino , Adulto , Fracturas no Consolidadas/cirugía , Osteonecrosis/cirugía , Trasplante Óseo/métodos , Fijación Interna de Fracturas/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Rango del Movimiento Articular , Adulto Joven , Adolescente , Tornillos Óseos , Arterias/cirugíaRESUMEN
Advanced endovascular techniques are increasingly being utilized to treat patients with peripheral arterial disease and chronic limb-threatening ischemia to improve lower extremity arterial perfusion. In diabetic patients, pedal arch patency has been associated with improved wound healing, limb salvage, and overall survival. Pedal-plantar loop revascularization is a technique that can restore arterial inflow between the dorsal and plantar arteries of the foot. This article will describe the inframallelolar arterial anatomy and focus on imaging, percutaneous endovascular techniques, and clinical study outcomes of pedal artery interventions.
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Procedimientos Endovasculares , Pie , Enfermedad Arterial Periférica , Grado de Desobstrucción Vascular , Humanos , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/cirugía , Resultado del Tratamiento , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Pie/irrigación sanguínea , Recuperación del Miembro , Flujo Sanguíneo Regional , Isquemia/fisiopatología , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Isquemia/terapia , Arterias/diagnóstico por imagen , Arterias/cirugía , Arterias/fisiopatología , Stents , Factores de RiesgoAsunto(s)
Colgajo Perforante , Procedimientos de Cirugía Plástica , Neoplasias de la Lengua , Humanos , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/trasplante , Procedimientos de Cirugía Plástica/métodos , Neoplasias de la Lengua/cirugía , Neoplasias de la Lengua/patología , Lengua/cirugía , Arterias/cirugía , Glosectomía/métodosAsunto(s)
Cirugía de Reasignación de Sexo , Colgajos Quirúrgicos , Vagina , Vulva , Humanos , Femenino , Vulva/cirugía , Vulva/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , Cirugía de Reasignación de Sexo/métodos , Vagina/cirugía , Masculino , Procedimientos de Cirugía Plástica/métodos , Adulto , Arterias/cirugíaRESUMEN
PURPOSE: Assessing the clinical effectiveness of combining with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold to repair mid-distal defects in adjacent fingers. METHODS: From September 2012 to April 2022, 21 patients with 42 mid-distal defects of adjacent fingers underwent treatment using combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold. The flaps size ranged from 2.1 cm * 1.6 to 4.9 cm * 3.2 cm. Follow-up evaluations included assessing function, sensation, and appearance, etc. of the injured fingers and donor areas. RESULTS: All 42 flaps survived in 21 patients without any vascular crises, and the wounds healed in phase I. The mean follow-up time was 12.2 months (range 7-22 months). During follow-up, in injured fingers, according to the Michigan Hand Outcomes Questionnaire (MHOQ), the functional recovery and appearance were satisfactory; in Dargan Function Evaluation (DFE), the results were both "excellent" in fourteen patients, "excellent" and "good" in five patients, both "good" in one patient, "good" and "general" in one. In static two-point discrimination (2PD), the variation ranges from 4 to 9 mm in injured fingers and 6-10 mm in donor toes. Cold Intolerance Severity Score (CISS) is mild in all patients. The visual analogue score (VAS) showed no pain in the injured fingers and donor toes. No deformities or other complications were noted at the donor toes. According to Chinese Manchester Foot Pain and Disability Index (C-MFPDI), there was no morbidity on foot function in all donor areas. CONCLUSION: The surgical procedure of combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of mid-distal adjacent fingers defect is highly satisfactory. This approach helps the injured fingers to achieve good function, sensibility and appearance, while also achieving satisfactory results in the donor toes.
Asunto(s)
Traumatismos de los Dedos , Procedimientos de Cirugía Plástica , Humanos , Masculino , Adulto , Femenino , Estudios Retrospectivos , Traumatismos de los Dedos/cirugía , Persona de Mediana Edad , Adulto Joven , Procedimientos de Cirugía Plástica/métodos , Colgajos Tisulares Libres , Estudios de Seguimiento , Resultado del Tratamiento , Andamios del Tejido , Adolescente , Arterias/cirugíaRESUMEN
Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through multidisciplinary collaboration and discuss decision making for challenging presentations. This review will concentrate on VGI that impacts both aneurysms and pseudoaneurysms excluding the ascending thoracic aorta.
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Procedimientos de Cirugía Plástica , Infecciones Relacionadas con Prótesis , Humanos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Prótesis Vascular/efectos adversos , Grupo de Atención al Paciente , Aneurisma Falso/cirugía , Aneurisma Falso/etiología , Arterias/cirugíaRESUMEN
OBJECTIVE: For traumatic lower extremity artery injury, it is unclear whether it is better to perform endovascular therapy (ET) or open surgical repair (OSR). This study aimed to compare the clinical outcomes of ET versus OSR for traumatic lower extremity artery injury. METHODS: The Medline, Embase, and Cochrane Databases were searched for studies. Cohort studies and case series reporting outcomes of ET or OSR were eligible for inclusion. Robins-I tool and an 18-item tool were used to assess the risk of bias. The primary outcome was amputation. The secondary outcomes included fasciotomy or compartment syndrome, mortality, length of stay and lower extremity nerve injury. We used the random effects model to calculate pooled estimates. RESULTS: A total of 32 studies with low or moderate risk of bias were included in the meta-analysis. The results showed that patients who underwent ET had a significantly decreased risk of major amputation (OR = 0.42, 95% CI 0.21-0.85; I2=34%) and fasciotomy or compartment syndrome (OR = 0.31, 95% CI 0.20-0.50, I2 = 14%) than patients who underwent OSR. No significant difference was observed between the two groups regarding all-cause mortality (OR = 1.11, 95% CI 0.75-1.64, I2 = 31%). Patients with ET repair had a shorter length of stay than patients with OSR repair (MD=-5.06, 95% CI -6.76 to -3.36, I2 = 65%). Intraoperative nerve injury was just reported in OSR patients with a pooled incidence of 15% (95% CI 6%-27%). CONCLUSION: Endovascular therapy may represent a better choice for patients with traumatic lower extremity arterial injury, because it can provide lower risks of amputation, fasciotomy or compartment syndrome, and nerve injury, as well as shorter length of stay.
Asunto(s)
Procedimientos Endovasculares , Extremidad Inferior , Humanos , Procedimientos Endovasculares/métodos , Extremidad Inferior/lesiones , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/mortalidad , Amputación Quirúrgica/métodos , Arterias/lesiones , Arterias/cirugía , Fasciotomía/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Síndromes Compartimentales/cirugía , Tiempo de Internación/estadística & datos numéricosRESUMEN
OBJECTIVE: The modern treatments of trauma have changed in recent years. We aim to evaluate the factors associated with limb salvage and mortality after extremity arterial trauma, especially with respect to the type of conduit used in revascularization. METHODS: The National Trauma Data Bank was queried to identify patients with upper and lower extremity (UE and LE) arterial injuries between 2016 and 2020. The patients were stratified by the types of arterial repair. The primary outcome was in-hospital mortality. RESULTS: 8780 patients were found with 5054 (58%) UE and 3726 (42%) LE injuries. Eighty-three percent were men, and the mean age was 34 ± 15 years. Penetrating mechanism was the predominant mode of injury in both UEs and LEs (73% and 67%, respectively) with a mean injury severity score of 14 ± 8. For UEs, the majority underwent primary repair (67%, P < .001), whereas the remainder received either a bypass (20%) or interposition graft (12%). However, LEs were more likely to receive a bypass (52%, P < .00001) than primary repair or interposition graft (34% and 14%, respectively). Compared with the extremely low rates of amputation and mortality among UE patients (2% for both), LE injuries were more likely to result in both amputation (10%, P < .001) and death (6%, P < .001). Notably, compared with primary repair, the use of a prosthetic conduit was associated with a 6.7-fold increase in the risk of amputation in UE and a 2.4-fold increase in LE (P < .0001 for both). Synthetic bypasses were associated with a nearly 3-fold increase in return to the operating room (OR) in UE bypasses (P < .05) and a 2.4-fold increase in return to the OR in LE bypasses (P < .0001). CONCLUSIONS: In recent years, most extremity vascular trauma was due to penetrating injury with a substantial burden of morbidity and mortality. However, both limb salvage rates and survival rates have remained high. Overall, LE injuries more often led to amputation and mortality than UE injuries. The most frequently used bypass conduit was vein, which was associated with less risk of unplanned return to the OR and limb loss, corroborating current practice guidelines for extremity arterial trauma.
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Amputación Quirúrgica , Arterias , Bases de Datos Factuales , Mortalidad Hospitalaria , Recuperación del Miembro , Extremidad Inferior , Lesiones del Sistema Vascular , Humanos , Masculino , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/mortalidad , Lesiones del Sistema Vascular/diagnóstico , Femenino , Adulto , Persona de Mediana Edad , Estados Unidos/epidemiología , Amputación Quirúrgica/estadística & datos numéricos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/lesiones , Factores de Riesgo , Estudios Retrospectivos , Resultado del Tratamiento , Factores de Tiempo , Adulto Joven , Arterias/lesiones , Arterias/cirugía , Extremidad Superior/irrigación sanguínea , Extremidad Superior/lesiones , Medición de Riesgo , Implantación de Prótesis Vascular/mortalidad , Implantación de Prótesis Vascular/efectos adversos , AdolescenteRESUMEN
Corona mortis (CM) is an anastomotic vessel between the inferior epigastric or external iliac vessels and the obturator or internal iliac vessels. The Latin meaning of it is 'crown of death' which corresponds to massive haemorrhage caused by injury to this vessel during surgery. The incidence of this vessel is around 50% in the hemipelvis. We are presenting an intraoperative video of a right laparoscopic totally extraperitoneal mesh hernioplasty demonstrating a CM artery in the right hemipelvis. Care was taken to prevent injury to this vessel. CO2 insufflation pressure was reduced to less than 10 mm Hg to see any venous variant of this vessel. Carefully, polypropylene mesh was placed without a fixation device. Anatomical knowledge of the CM vessel is therefore essential in preventing injury for surgeons who approach the inguinal and retropubic regions.
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Hernia Inguinal , Laparoscopía , Humanos , Arteria Ilíaca/cirugía , Herniorrafia , Mallas Quirúrgicas/efectos adversos , Arterias/cirugía , Hernia Inguinal/cirugíaRESUMEN
The free medial sural artery perforator (MSAP) flap is a recently popularized flap. It has evolved from a composite myocutaneous flap to a pedicled perforator flap for lower limb reconstruction. It is also a versatile free perforator flap for extremity and head and neck reconstruction. The diversity of the flap designs with options for harvest of non-vascularized grafts enhances the versatility for hand and upper limb reconstruction. The adjunctive use of endoscopy and indocyanine green fluorescence imaging studies can assist and demystify the flap anatomy. The authors present their experience using free MSAP flaps for complex mutilated hand and upper extremity reconstruction.
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Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Colgajo Perforante/irrigación sanguínea , Extremidad Superior/cirugía , Arterias/cirugíaRESUMEN
The profunda artery perforator (PAP) flap provides a good option for hand and upper extremity reconstruction. The reliable quality, caliber, and number of perforators in the posteromedial thigh support large flaps with long pedicles. The PAP flap has been widely used for breast reconstruction, although its use in the extremities has been slower to catch on due to the bulk and thickness of the subcutaneous tissue. The authors discuss evolution of thin flaps and our application of the thin and superthin PAP flap for upper extremity reconstruction.
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Mamoplastia , Colgajo Perforante , Humanos , Colgajo Perforante/irrigación sanguínea , Arterias/cirugía , Extremidad Superior/cirugía , Mano/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Lack of adequate recipient vessels in certain anatomically unfavorable locations or in complex clinical situations is still a limitation to successful microsurgical transfer. To address such complex cases, advanced microsurgical techniques should be applied. In this paper, the authors describe their experience with the Extra-anatomical Pedicle Rerouting (EPR) technique, an alternative approach that was used in selected cases throughout the body to obtain healthy recipient vessels for microsurgical reconstruction in unfavorable clinical situations where suitable recipient vessels were difficult to find. PATIENTS AND METHODS: Fifteen patients with defects of variable etiology (oncological resection, trauma, previous surgeries) located in the trunk or upper and lower extremities received EPR free flap reconstruction at our Institution. Operative data, postoperative course, and complications were recorded. Clinical and photographic follow-ups were also documented. RESULTS: A total of 15 flaps (6 antero-lateral thigh (ALT), 6 latissimus dorsi/thoracodorsal artery perforator flap (LD/TDAP), 3 deep inferior epigastric artery perforator flap (DIEP)) were transferred adopting the EPR technique for oncological (11) and post-traumatic (4) defects. According to the different clinical scenarios, the rerouted vessels were the thoraco-acromial, posterior circumflex humeral, thoracodorsal, deep inferior epigastric, lateral circumflex femoral, anterior tibial, and medial sural pedicles. Mean length of the rerouted vascular conduits was 6.53 cm. Mean operative time was 420 minutes. No major complications were registered. Minor wound dehiscence was observed and managed conservatively in 3 patients. CONCLUSIONS: The EPR technique proved to be useful in a reliable and reproducible manner in different regions of the body as an alternative solution to obtain healthy recipient vessels in anatomically and surgically unfavorable clinical situations.
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Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Colgajos Quirúrgicos/irrigación sanguínea , Arterias/cirugía , Extremidad Inferior , Muslo , Colgajo Perforante/irrigación sanguíneaRESUMEN
PURPOSE: This retrospective study aimed to identify the factors that affect the duration of thoracodorsal artery perforator (TDAP) free-flap surgery and to offer strategies for optimizing the surgical procedure. METHODS: We analyzed 80 TDAP flap surgeries performed by a single surgeon between January 2020 and December 2022, specifically focusing on free flaps used for lower-extremity defects with single-artery and single-vein anastomosis. The operation duration was defined as the time between the surgeon's initial incision and completion of reconstruction. Linear regression analyses were conducted to identify the factors affecting operation duration. RESULTS: The average operative duration was 149 minutes (range, 80-245 minutes). All flaps survived, although 8 patients experienced partial flap loss. The operative duration decreased with increasing patient age and when end-to-end arterial anastomosis was performed. However, the risk increased with larger flap sizes and in patients with end-stage renal disease. CONCLUSIONS: Our study identified several factors and methods that could accelerate TDAP free-flap procedures. These findings offer valuable insights for optimizing surgical processes and improving overall surgical outcomes. Although further research is needed to confirm and expand upon these findings, our study provides important guidance for surgeons in developing effective strategies for TDAP flap surgery.
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Colgajos Tisulares Libres , Colgajo Perforante , Procedimientos de Cirugía Plástica , Humanos , Colgajos Tisulares Libres/irrigación sanguínea , Estudios Retrospectivos , Colgajo Perforante/irrigación sanguínea , Arterias/cirugía , Extremidad Inferior/cirugíaRESUMEN
Endoscopic repair of large nasal septal perforation (SP) remains a rather challenging procedure. The presented modification of vascularized flap, which is supplied with branches of posterior septal artery, has proven to be convenient and effective in closure of SPs larger than 2 cm. Laryngoscope, 134:3485-3488, 2024.
Asunto(s)
Endoscopía , Perforación del Tabique Nasal , Tabique Nasal , Colgajos Quirúrgicos , Humanos , Perforación del Tabique Nasal/cirugía , Colgajos Quirúrgicos/trasplante , Colgajos Quirúrgicos/irrigación sanguínea , Endoscopía/métodos , Tabique Nasal/cirugía , Masculino , Femenino , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Arterias/cirugía , Arterias/lesionesRESUMEN
OBJECTIVE: Autologous vein is the preferred bypass conduit for extremity arterial injuries owing to superior patency and low infection risk; however, long-term data on outcomes in civilians are limited. Our goal was to assess short- and long-term outcomes of autologous vein bypass for upper and lower extremity arterial trauma. METHODS: A retrospective review was performed of patients with major extremity arterial injuries (2001-2019) at a level I trauma center. Demographics, injury and intervention details, and outcomes were recorded. Primary outcomes were primary patency at 1 year and 3 years. Secondary outcomes were limb function at 6 months, major amputation, and mortality. Multivariable analysis determined risk factors for functional impairment. RESULTS: There were 107 extremity arterial injuries (31.8% upper and 68.2% lower) treated with autologous vein bypass. Mechanism was penetrating in 77% of cases, of which 79.3% were due to firearms. The most frequently injured vessels were the common and superficial femoral (38%), popliteal (30%), and brachial arteries (29%). For upper extremity trauma, concomitant nerve and orthopedic injuries were found in 15 (44.1%) and 11 (32.4%) cases, respectively. For lower extremities, concomitant nerve injuries were found in 10 (13.7%) cases, and orthopedic injuries in 31 (42.5%). Great saphenous vein was the conduit in 96% of cases. Immediate intraoperative bypass revision occurred in 9.3% of patients, most commonly for graft thrombosis. The in-hospital return to operating room rate was 15.9%, with graft thrombosis (47.1%) and wound infections (23.5%) being the most common reasons. The median follow-up was 3.6 years. Kaplan-Meier analysis showed 92% primary patency at 1 year and 90% at 3 years. At 6 months, 36.1% of patients had functional impairment. Of patients with functional impairment at 6 months, 62.9% had concomitant nerve and 60% concomitant orthopedic injuries. Of those with nerve injury, 91.7% had functional impairment, compared with 17.8% without nerve injury (P < .001). Of patients with orthopedic injuries, 51.2% had functional impairment, vs 25% of those without orthopedic injuries (P = .01). On multivariable analysis, concomitant nerve injury (odds ratio, 127.4; 95% confidence interval, 17-957; P <. 001) and immediate intraoperative revision (odds ratio, 11.03; 95% confidence interval, 1.27-95.55; P = .029) were associated with functional impairment. CONCLUSIONS: Autologous vein bypass for major extremity arterial trauma is durable; however, many patients have long-term limb dysfunction associated with concomitant nerve injury and immediate intraoperative bypass revision. These factors may allow clinicians to identify patients at higher risk for functional impairment, to outline patient expectations and direct rehabilitation efforts toward improving functional outcomes.