Ferulización de la microanastomosis arterial tras elongar el pedículo con injerto venoso. Caso clínico

Arterial splinting is a modification of the aortic aneurysm site wrapping technique performed in cardiothoracic surgery. In microsurgery, we modify the technique without completely wrapping the anastomosis site when angulation occurs, but only splinting it to decrease angulation of the arterial anastomosis caused by turbulence in the passage of blood flow and lengthening of the pedicle using a vein graft such as bridge between the recipient vessel and the flap pedicle. We present a case of resection of mandibular carcinoma and reconstruction with fascia lata tensor free flap that, 32 hours after surgery, suffered profuse bleeding due to avulsion of the arterial microanastomosis. We used 16 cm of the saphenous vein to reconstruct the tear in the arterial pedicle and lengthen it in order to decrease the tension in the microanastomosis of the recipient vessel and the pedicle of the free flap. After microanastomosis, angulation of the pedicle occurs and noticed a 10-second delay in capillary filling after needle puncture of the free flap. We reserved 4 cm of the vein graft to splinting the angulation site of the arterial microanastomosis with the vein graft, achieving a decrease in the angle of the microanastomosis and a capillary filling of 2 to 3 seconds, thus improving the perfusion of the free flap.