游离皮瓣被认为是重建各种缺损的黄金标准。微血管吻合是决定游离皮瓣手术成功的非常关键的组成部分。一直使用手工缝合技术进行微血管吻合,取得了出色的效果。最近,静脉连接器越来越多地用于进行静脉吻合。我们描述了一个14岁女孩的案例,其中计划对跟骨区域的不稳定疤痕和慢性骨髓炎进行脚跟重建,并带有游离的背阔肌肌皮瓣。动脉吻合是通过手工缝合完成的,而静脉耦合器(GEM耦合器,Synovis微型公司联盟)用于静脉吻合。就在伤口闭合之前,静脉耦合器自发地打开,导致装置的破坏和吻合口的打开。确保止血后,试图移除耦合装置的环,但是由于互锁的销钉,它粘附在外膜上。在需要静脉移植物的情况下,切割环近侧的静脉将导致静脉的缩短。收获的背阔肌只有一条腔静脉,必须抢救,因此,我们通过从互锁销外翻静脉边缘,并在新鲜边缘后用手完成吻合来即兴发挥。互锁环就这样留在了他们的位置。术后期间平安无事,皮瓣存活了很好的效果.因此,这是一个独特的案例,我们首次报告了静脉耦合装置的破坏以及随后的游离皮瓣的抢救。
Free flaps are considered the gold standard for the reconstruction of various defects. Microvascular anastomosis is a very critical component of free flap surgery determining its success. The workhorse technique of hand suturing for microvascular anastomosis has consistently been used with excellent results. Recently, venous couplers are being increasingly used for performing venous anastomosis. We describe the
case of a 14-year-old girl in which heel reconstruction was planned for an unstable scar and chronic osteomyelitis of the calcaneal region with a free latissimus dorsi muscle flap. Arterial anastomosis was done by hand suturing, while venous coupler (GEM coupler, Synovis Micro Companies Alliance) was used for venous anastomosis. Just before wound closure, the venous coupler spontaneously snapped open, resulting in disruption of the device and opening of the anastomosis. After securing hemostasis, the ring of the coupling device was tried to be removed, but it was adhered to the tunica externa due to the interlocking pins. Cutting the veins proximal to the rings would result in shortening of the vein with the requirement of a vein graft. The harvested latissimus dorsi muscle had a single vena comitans which had to be salvaged, so we improvised by everting the vein edges from the interlocking pins and completing the anastomosis by hand after freshening the margins. The interlocking rings were left as such in their place. Postoperative period was uneventful, and the flap survived with good results. Thus, this is a unique
case where we report for the first time the disruption of a venous coupling device and subsequent salvage of free flap.