Venous Complications in One Versus Two Vein Anastomoses in Head and Neck Free Flaps

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Objective: The purpose of this study was to compare rates of reexploration and flap failure in patients with 1- and 2-vein anastomoses in free flap reconstructions. Methods: Retrospective chart review of 300 patients undergoing free flap reconstruction to head and neck defects from 2010 to 2014. Results: One venous anastomosis was performed in 229 patients, and 2 venous anastomoses were performed in 71 patients. The 1-vein group had significantly more reexplorations in the operating room (36/229, 15.7%) compared with the 2-vein group (4/71, 5.6%; P =.028), even when controlling for flap type (P =.022). This finding remained true among radial forearm flaps (17/81, 21% vs 3/53, 5.7%; P =.024). The number of venous anastomoses was not significantly associated with flap failure, though patients with flap failure did have a significantly greater proportion of venous issues (P <.001). Conclusions: Two-vein anastomoses do not appear to reduce rates of flap failure or postoperative venous thrombosis but are associated with a lower number of reexplorations in the operating room even after accounting for differences in flap types and surgeons.

Original languageEnglish (US)
Pages (from-to)722-726
Number of pages5
JournalAnnals of Otology, Rhinology and Laryngology
Issue number10
StatePublished - Oct 1 2017


  • free flap reconstruction
  • free tissue transfer
  • head and neck reconstruction
  • microvascular reconstruction
  • miscellaneous
  • surgical outcomes


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