Analysis of free flap viability based on recipient vein selection

Area of Science:

• Plastic Surgery
• Microsurgery
• Head and Neck Reconstruction

Background:

• Venous anastomotic failure is a leading cause of microvascular free tissue transfer failure.
• Two common venous anastomosis configurations exist: end-to-end and end-to-side.
• Optimal venous anastomosis configuration for flap survival remains debated.

Purpose of the Study:

• To evaluate the impact of venous anastomosis configuration on microvascular free flap survival rates.
• To compare flap survival between end-to-end and end-to-side venous anastomoses.

Main Methods:

• Retrospective analysis of 786 microvascular free flaps for head and neck defects (1993-2007).
• Flaps with a single venous anastomosis were stratified into end-to-end and end-to-side groups.
• Bivariate and multivariate analyses compared flap re-exploration and failure rates.

Main Results:

• 87% of flaps utilized an end-to-end anastomosis, while 13% used an end-to-side configuration.
• Overall flap re-exploration rate was 4.3%, and flap failure rate was 1.1%.
• Multivariate analysis showed no significant difference in flap re-exploration or failure rates between end-to-end and end-to-side venous anastomoses.

Conclusions:

• Venous anastomosis configuration (end-to-end vs. end-to-side) does not influence microvascular free flap survival.
• Reconstructive surgeons should be proficient in both techniques to maximize flap success.
• This study supports flexibility in choosing venous anastomosis methods based on surgical context.