Free Flap Survival Despite Internal Jugular Vein Thrombosis in Head and Neck Reconstruction

Abstract

Summary:Microvascular free tissue transfer is one of the most common techniques of reconstruction for complex head and neck surgical defects. Generally, venous thrombosis is more likely to occur than arterial thrombosis in vascular anastomosis. Thus, recipient veins must be chosen carefully. Although the internal jugular vein is preferred as a recipient vein by many microsurgeons, internal jugular vein thrombosis is a potential complication, as shown in our report. Therefore, we consider that the external jugular vein still is an option as a recipient for venous anastomosis and that it is better to perform multiple vein anastomoses with 2 different venous systems, such as the internal and external jugular systems, than anastomoses within the same venous system.

Disappearance of Internal Jugular Vein Thrombosis After Use of Edoxaban Following Head and Neck Reconstruction: A Case Report

“…However, after head and neck reconstruction, IJVT is not likely to cause flap congestion and necrosis, and treatment is necessary. Many reports recommend anastomosing the flap vein into two systems, such as the internal jugular vein and the external jugular vein, to avoid flap congestion due to IJVT [11][12][13]. Although we usually try to anastomose two veins in the internal jugular vein and external jugular vein if possible, we experienced a thrombosis in both the internal jugular vein and the external jugular vein in a case in which the flap was congested.…”

Free jejunal flap transfer with multiple vascular pedicles for safe and reliable pharyngoesophageal reconstruction

“…16 In our procedure, a long jejunum segment is harvested, which is a new approach with additional benefits. Although a single anastomosis is sufficient for flap survival, we consider that there is room for improvement because single anastomosis is still associated with some flap loss, and that anastomoses of multiple pairs of arteries and veins ensures flap survival.…”

“…Postoperative CT images revealed complete thrombosis of the left internal jugular vein, including the anastomosed site, although the flap completely survived, apparently because the external jugular vein had been patent as the drainage vein. 16 In our procedure, a long jejunum segment is harvested, which is a new approach with additional benefits. Specifically, the redundant mesentery could be used as a mesenteric flap to fill in the dead space, protect major vessels, such as the carotid artery, and cover the intestinal anastomotic area, thereby decreasing postoperative complications, such as infection, carotid rupture, and possibly fistula formation.…”