Flap Failure and Re-exploration in Head and Neck Free Tissue Reconstruction: The Impact of the Venous System Choice

Background and objective Free tissue transfer is widely performed in head and neck reconstruction. However, venous thrombosis at the vascular anastomosis remains a serious complication and a major cause of re-exploration. Hence, we conducted a retrospective case series study to evaluate risk factors for venous thrombosis that induce re-exploration. Methods We conducted a retrospective review of 143 flaps for head and neck defects treated at our institution between August 2015 and March 2023. The following patient-related and operative variables were collected from the clinical records: recipient vein, age at the time of surgery, sex, tumor site, flap type, operation time, volume of blood loss, chronic comorbidity, and hematologic status. Results Re-exploration due to flap failure was performed in eight cases (5.6%), two of which could be salvaged, and six of which required further reconstruction. The overall flap survival rate was 95.8%. Cases with a single anastomosis to the superficial venous system (SVS) presented a higher risk of re-exploration than those with an anastomosis to the deep venous system (DVS). Conclusions Based on our findings, single anastomosis to the SVS, when the internal jugular vein is unavailable, is associated with a higher risk of re-exploration.