title: Flow-through anastomosis using a T-shaped vascular pedicle for gracilis functioning free muscle transplantation in brachial plexus injury.
abstract: OBJECTIVE
  In gracilis functioning free muscle transplantation, the limited caliber of the dominant vascular pedicle increases the complexity of the anastomosis and the risk of vascular compromise. The purpose of this study was to characterize the results of using a T-shaped vascular pedicle for flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury.
  
  
  METHODS
  The outcomes of patients with brachial plexus injury who received gracilis functioning free muscle transplantation with either conventional end-to-end anastomosis or flow-through anastomosis from 2005 to 2013 were retrospectively compared. In the flow-through group, the pedicle comprised a segment of the profunda femoris and the nutrient artery of the gracilis. The recipient artery was interposed by the T-shaped pedicle.
  
  
  RESULTS
  A total of 46 patients received flow-through anastomosis, and 25 patients received conventional end-to-end anastomosis. The surgical time was similar between the groups. The diameter of the arterial anastomosis in the flow-through group was significantly larger than that in the end-to-end group (3.87 mm vs. 2.06 mm, respectively, p<0.001), and there were significantly fewer cases of vascular compromise in the flow-through group (2 [4.35%] vs. 6 [24%], respectively, p=0.019). All flaps in the flow-through group survived, whereas 2 in the end-to-end group failed. Minimal donor-site morbidity was noted in both groups.
  
  
  CONCLUSIONS
  Flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury can decrease the complexity of anastomosis, reduce the risk of flap loss, and allow for more variation in muscle placement.
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hou
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Jiantao
authors.initials: J
authors.lastname: Yang
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Bengang
authors.initials: B
authors.lastname: Qin
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Guo
authors.initials: G
authors.lastname: Fu
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiangming
authors.initials: X
authors.lastname: Li
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Liqiang
authors.initials: L
authors.lastname: Gu
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Liu
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Qingtang
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Sun Yat-sen University, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Qi
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D001158:Arteries / Q000601:surgery; D001917:Brachial Plexus / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D061646:Operative Time; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013848:Thigh; D016896:Treatment Outcome; D055815:Young Adult