title: Vein grafting your way out of trouble: Examining the utility and efficacy of vein grafts in microsurgery.
abstract: BACKGROUND
  There is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique.
  
  
  METHODS
  All microsurgical cases at a single institution from 2005 to 2011 were examined for use of IVGs in the primary procedure or during take back or salvage attempts. We examined the cohort overall and performed a subgroup analysis by timing of initial IVG.
  
  
  RESULTS
  In the study period, 1718 patients underwent 2368 free flaps. 51 IVGs were utilized in 38 patients (2.2%) and 38 flaps (1.6%). Eight (42.1%) of the primary procedure IVGs (n = 19) were planned preoperatively. Nine total flap losses (24%) occurred when IVGs were utilized, 89% of which occurred in the take back cohort (p = 0.02). However, planned IVG had a 100% success rate, and IVG utilized in the primary procedure overall had a 95% success rate. Importantly, A significantly higher rate of thrombotic events was noted in all primary cases where IVGs were utilized (p = 0.005).
  
  
  CONCLUSIONS
  This study demonstrates that IVGs can be utilized in primary free flap reconstructions with success rates exceeding 95%. However, in salvage procedures, the use of vein grafts does not approach the same rate of success likely due to multiple factors. Yet when utilized appropriately with thrombectomy and resection of the thrombosed vessel to healthy intima, IVGs can provide an important tool for flap salvage.
  
  
  METHODS
  prognostic/risk category, level II.
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jonas.nelson@uphs.upenn.edu.
authors: Jonas A
authors: JA
authors: Nelson
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: John P
authors: JP
authors: Fischer
authors: Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors: Ritwik
authors: R
authors: Grover
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Stephen J
authors: SJ
authors: Kovach
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: David W
authors: DW
authors: Low
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Suhail K
authors: SK
authors: Kanchwala
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: L Scott
authors: LS
authors: Levin
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Joseph M
authors: JM
authors: Serletti
authors: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors: Liza C
authors: LC
authors: Wu
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001158:Arteries / Q000637:transplantation; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D058752:Free Tissue Flaps; D006085:Graft Survival; D006257:Head / Q000601:surgery; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D009333:Neck / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000706:statistics & numerical data*; D014680:Veins / Q000637:transplantation
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin
keywords: Free flap; Interpositional; Microsurgery; Salvage; Vein graft