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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
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Go Deep or Go Home: Evaluating Venous Drainage Systems in Microvascular Lower Extremity Reconstruction.
Imran Rizvi1, Bora Kahramangil1, Ellen Wang1
1Division of Plastic and Reconstructive Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, United States.
Journal of Reconstructive Microsurgery
|October 9, 2025
Summary
Free flaps for lower extremity reconstruction using superficial veins showed higher complication rates. Deep venous drainage is preferred, but superficial veins can be used adjunctively.
Area of Science:
- Vascular Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Consensus is lacking on using superficial versus deep veins for lower extremity free flaps in limb salvage.
- Venous complications are a significant concern in free flap procedures.
Purpose of the Study:
- To analyze the risks of venous complications associated with superficial and deep venous anastomoses in lower extremity free flap reconstruction.
- To compare complication rates between superficial, deep, and combined venous drainage systems.
Main Methods:
- Retrospective review of 333 patients undergoing lower extremity free flap reconstruction (2016-2024).
- Recipient veins classified as deep (venae comitantes) or superficial (saphenous).
- Composite venous complications (congestion, hematoma, necrosis) were the primary outcome.
Main Results:
- Overall, 9.3% of patients experienced venous complications.
- Superficial-only venous drainage had a significantly higher complication rate (27.8%) compared to deep (8.6%) or combined (4.3%).
- Multivariate analysis indicated superficial vein use increased odds of complications (OR=4.11).
Conclusions:
- Superficial venous drainage in lower extremity free flaps is associated with higher rates of venous complications.
- Prioritizing deep venous systems is recommended, with superficial veins considered as adjuncts.
- Careful consideration and patient selection are crucial when utilizing superficial veins for reconstructive outcomes.
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