Complex reconstructive microsurgery cases: the role of arteriovenous loops

Abstract

In free-flap reconstructive microsurgery, arteriovenous loops can be a useful tool when adequate recipient vessels are absent. We present a case series of 12 patients in which this technique was used. Between 2000 and 2019, 12 patients with complex defects had free-flap reconstruction with the use of arteriovenous loops. There was a total of 9 men and 3 women, ranging in age from 22 to 71 years old. Six patients had post-traumatic lower limb defects, and 5 of them were reconstructed with latissimus dorsi free-flaps. The other six patients had head and neck defects in a previously irradiated field, and 3 of them were reconstructed with free osteofasciocutaneous fibula flaps. All the procedures were performed in a single-stage approach. There were 2 cases of total flap failure both in patients with multiple risk factors and several previous surgeries. One of the patients died because of a carotid artery blow-out on the second postoperative day. No other major complications were recorded. The mean hospitalization time was 60 days. The mean follow-up time was 31.1 months. Overall flap survival was 75%. This case series illustrates how free-flap surgery can be even more challenging when the surgical conditions are especially unfavorable. Arteriovenous loops proved to be an excellent technical resource allowing reconstruction with anastomosis on healthy distant vessels. Despite the good results with single-stage interventions, our opinion is that decision between single- and two-stage approach should be made case-by-case. Level of evidence: Level IV, therapeutic study.