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Factors Associated With Venous Complications in Lower Extremity Free Flap Reconstruction: A Multivariate Analysis.

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Using the superficial venous system as the sole drainage route increases venous complications in lower extremity (LE) free flaps (FFs). Dual venous anastomoses do not reduce congestion risk, and veins within the zone of injury may be safely used.

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Area of Science:

  • Microsurgery
  • Vascular Surgery
  • Reconstructive Surgery

Background:

  • Lower extremity (LE) free flaps (FFs) are susceptible to venous complications due to their anatomical location.
  • Identifying risk factors for venous complications in LE FFs is crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze the risk factors associated with venous complications in patients undergoing lower extremity free flap reconstruction.
  • To determine the impact of venous anastomosis strategy and vein selection on the incidence of venous complications.

Main Methods:

  • A retrospective review of 370 adult patients undergoing LE FF reconstruction from 2016 to 2025 was performed.
  • Data collected included patient demographics, wound and operative characteristics, and number of venous anastomoses.
  • Venous complications, defined as venous congestion, flap loss due to venous causes, or flap hematoma, were the primary outcome.

Main Results:

  • The overall venous complication rate was 7.3%.
  • The use of the superficial venous system as the sole venous drainage route was the only independent predictor of venous complications (OR, 14.5; P=0.013).
  • Age, sex, comorbidities, flap type, vein location (inside/outside zone of injury), and single vs. dual venous anastomosis were not significantly associated with venous complications.

Conclusions:

  • Sole reliance on the superficial venous system for drainage in LE FFs significantly increases the risk of venous complications compared to deep vein anastomoses.
  • Performing a second venous anastomosis routinely does not mitigate the risk of venous congestion.
  • Veins located within the zone of injury can be safely utilized for venous anastomosis when necessary.