Dual venous outflow improves lower extremity trauma free flap reconstructions

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Vascular Surgery

Background:

• Venous outflow compromise is a primary cause of perioperative flap failure.
• The role of dual venous anastomoses in lower extremity trauma free flap reconstruction remains under-investigated.

Purpose of the Study:

• To evaluate the impact of dual-vein outflow on complication rates in lower extremity trauma free flap reconstruction.

Main Methods:

• Retrospective review of 464 free flaps for lower leg trauma reconstruction (1979-2014).
• Preliminary analysis of 219 randomly selected flaps, comparing single-vein vs. dual-vein outflow outcomes.
• Multivariable regression analysis controlled for various patient and flap characteristics.

Main Results:

• Dual-vein outflow was associated with significantly lower rates of overall complications (RR=0.269, P=0.001), partial flap loss (RR=0.351, P=0.031), and any flap failure (RR=0.31, P=0.010).
• Dual-vein anastomoses were more common in smaller fasciocutaneous flaps.
• No significant difference in operative time was observed between single-vein and dual-vein outflow groups.

Conclusions:

• Dual-vein outflow demonstrates a protective effect, reducing overall complications by 73% and flap failure by 69%.
• The findings support the preferential use of two venous anastomoses in lower extremity trauma free flap reconstruction when feasible, without increasing operative time.