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One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis.
Jennifer L K Matthews1, Noor Alolabi2, Forough Farrokhyar2,3
1Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Plastic Surgery (Oakville, Ont.)
|May 31, 2018
Summary
Performing two venous anastomoses in free flap surgery may reduce reoperation rates due to venous congestion. However, evidence quality is low, and comparing different venous systems requires more data.
Area of Science:
- Microsurgery
- Plastic Surgery
- Vascular Surgery
Background:
- The necessity of a second venous anastomosis in free flap surgery remains debated.
- Venous congestion is a critical complication in free flap procedures.
Purpose of the Study:
- To determine if two venous anastomoses reduce flap failure and reoperation rates.
- To assess if using two veins from different drainage systems impacts outcomes.
Main Methods:
- Systematic review and meta-analysis of 15 studies.
- Data extraction on flap failure and reoperation rates secondary to venous congestion.
- Pooled odds ratios (ORs) using a random-effects model with 95% confidence intervals (CIs).
Main Results:
- No significant difference in venous flap failure between one versus two venous anastomoses (OR: 1.35).
- A significant decrease in reoperation rates due to venous congestion was observed with two anastomoses (OR: 3.03).
- Results suggest a potential benefit for using two veins from different systems (OR: 0.16).
Conclusions:
- Low-quality evidence indicates that two venous anastomoses may lower reoperation rates for venous congestion.
- Insufficient data exists to compare outcomes of two venous anastomoses from different versus the same drainage systems.
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