Single Versus Double Venous Anastomosis Microvascular Free Flaps for Head and Neck Reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Venous congestion is a primary cause of microvascular free tissue flap failure.
• The optimal number of venous outflow anastomoses (single vs. dual) remains debated in head and neck reconstruction.

Purpose of the Study:

• To evaluate the institutional experience comparing single versus dual venous anastomoses in microvascular free flaps for head and neck reconstruction.
• To assess the impact of the number of venous anastomoses on complication rates, particularly venous congestion.

Main Methods:

• Retrospective chart review of 279 patients undergoing free flaps (anterolateral thigh, radial forearm, or fibula) for head and neck reconstruction between 2008 and 2020.
• Patients were classified based on the number of venous anastomoses (1 vs. 2) and compared for postoperative outcomes.
• Key outcomes analyzed included overall complications, flap failure, return to OR, hematoma, length of stay, and venous congestion.

Main Results:

• Most flaps (83.8%) utilized a single venous anastomosis.
• No statistically significant differences were observed in overall complications (P=0.788), flap failure (P=1.0), return to OR (P=1.0), hematoma (P=0.225), length of stay (P=0.725), or venous congestion (P=0.479) between groups.
• The rate of venous congestion was similar for flaps with one versus two venous anastomoses in this cohort.

Conclusions:

• The number of venous anastomoses (one vs. two) did not significantly impact flap outcomes or venous congestion in this head and neck reconstruction cohort.
• The decision to perform a second venous anastomosis should be individualized, considering anatomical factors, vessel characteristics, flap size, and intraoperative assessment.