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

Zhan, Kevin Y.; Rubin, Nathan; Bayon, Rodrigo

doi:10.1177/0003489417728089

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…18 Conversely, Khaja et al proved that two vein anastomoses in head and neck free flap did not reduce flap failure rate or postoperative venous thrombosis. 19 In this study, the number of recipient veins did not have any impact on the speech outcome after tongue reconstruction. Further large-scale studies are warranted to verify the correlation between the number of vein anastomosis and the functional outcome of the free flap in head and neck reconstruction.…”

Section: Discussionmentioning

confidence: 51%

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Jeong

et al. 2020

J Reconstr Microsurg

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Background Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction. Methods Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline. Results Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes. Conclusion We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

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Section: Discussionmentioning

confidence: 51%

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Jeong

et al. 2020

J Reconstr Microsurg

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“…On 854 patients, it was demonstrated that factors, such as age, smoking, and prior irradiation, in particular, do not affect flap survival [20]. Because venous thrombosis is the most common cause of vascular complications, many surgeons recommend anastomosing two veins [21][22][23]. Interestingly, in regression analysis, we could not find any advantage of dual or triple venous anastomosis compared to a single-vein anastomosis (P = 0.904).…”

Section: Discussionmentioning

confidence: 82%

Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin

Sievert

Goncalves

Tamse

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Free flap reconstruction is a valuable technique to preserve function in oncological head and neck surgery. Postoperative graft thrombosis is a dreaded risk. This study aims to compare low-dose unfractionated heparin (UFH) and lowmolecular-weight heparin (LMWH) in perioperative thrombosis prophylaxis. Methods This is a retrospective analysis of 266 free flaps performed at our academic center. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols either with UFH (n = 87) or LMWH (n = 179). Primary endpoints were the frequency of transplant thrombosis and the number of flap failures. Secondary endpoints were the occurrence of peri-and postoperative complications. Results The flap survival rate was 96.6% and 93.3% for the groups UFH and LMWH, respectively (P = 0.280). The rate of postoperative bleeding requiring revision was 4.6% and 6.7% for each group, respectively (P = 0.498). We found a hematoma formation in 4.6% and 3.9% (P = 0.792). Conclusion The free-flap survival rate using low-dose UFH seems to be equivalent to LMWH regimens without compromising the postoperative outcome. Consequently, for risk-adapted thrombosis prophylaxis, either LMWH or UFH can be administrated.

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“…Hence, opined that execution of two venous anastomoses has significant effect on reducing the vascular compromise and free flap failure rate in head and neck reconstruction. One more study done by Khaja et al (2017) compared 229 patients with one vein anastomosis and 71 patients of two vein anastomosis, concluded that two vein anastomoses did not reduce the flap failure rate or the post‐operative venous thrombosis. In lower limb majority of the studies found that number of vein anastomoses did not influence the flap success or failure rate.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of clinical outcome in ALT free flap reconstruction using superficial or deep and single or dual recipient vein anastomosis in different sites

Nagabhushanaiah,

Srinivas,

Parasuramulu

et al. 2023

Microsurgery

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Background: During the free flap surgery obtaining a suitable recipient vein is an important factor for successful outcome. As in all other flaps even in ALT flap, single or double venous anastomosis, superficial or deep venous anastomosis is still a matter of debate among the micro vascular surgeons. Though dual vein anastomosis is a time-tested method, single vein anastomosis has the advantage of reducing the operative time and hospitalization cost. Similarly, in situation where the deep veins are dubious superficial veins are savior. This study explores the outcome of ALT flap using different system of recipient veins. Patients and Methods: Retrospective analysis of the 54 free ALT flaps performed over a period of 5 years from June 2017 till June 2022, was carried out. Out of 54, 38 (63%) were male patients and 16 (37%) were females. The outcome of the flaps was evaluated in single or dual anastomosis group. Similarly, the outcome of the flaps with deep or superficial vein anastomosis was also evaluated. The flaps outcomes are evaluated as favorable (successful as well as partial loss are considered as favorable) and unfavorable (complete loss of the flap).Results: Among the 54 flaps, 31 patients had lower limb reconstruction, majority were post-traumatic defects. Twenty patients had head and neck reconstruction following post malignancy excision. Three patients had upper-limb reconstruction for post traumatic and burn injury defects. The outcome was analyzed. Twenty patients had dual vein anastomosis, 90% (18 out of 20) of patients had favorable outcome and 10% (2 out of 20) had unfavorable outcome. Thirty-four patients underwent single vein anastomosis, 94% had favorable outcome and 6% had unfavorable outcome.The result was not statistically significant as p < .05. Seven patients underwent superficial vein recipient anastomosis, and all flaps were (100%) successful and no failure, whereas out of 27 patients who had undergone deep vein anastomosis 25 (92%) had favorable outcome and 2 (8%) had unfavorable outcome. The results were not statistically significant as p > .05.

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

Abstract: 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.

Cited by 10 publications

References 8 publications

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin

A comparative study of clinical outcome in ALT free flap reconstruction using superficial or deep and single or dual recipient vein anastomosis in different sites

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