J Reconstr Microsurg 2020; 36(02): 073-081
DOI: 10.1055/s-0039-1695054
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

Jong Woo Choi
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Young Chul Kim
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Dong Neok Jeon
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Woo Shik Jeong
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Kyung S. Koh
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Tae Suk Oh
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Jin Sup Eom
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Eun Key Kim
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Joon Pio Hong
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
,
Hyunsuk Peter Suh
1   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

25 March 2019

07 July 2019

Publication Date:
26 August 2019 (online)

Abstract

Background This study was conducted to evaluate the impact of choosing a particular recipient venous system on venous patency and flap survival in 652 head and neck free flap reconstructions.

Methods A retrospective review was performed. Patient factors investigated included: age, sex, type of flap, tumor location, history of radiation, presence of previous neck dissection, tumor stage, and any underlying disease. Data related with recipient vein including the number of anastomosis, the repair technique, the type of recipient vein, and the configuration of selected venous system were examined. The impact of patient factors and parameters related with recipient vein on the venous patency and flap survival were analyzed using bivariate and multivariate analyses.

Results Of 652 free flaps, 36 flaps (5.5%) were re-explored due to venous congestion and 28 flaps (77.8%) were salvaged. The overall survival rate of total free flaps was 98.8%. The type of recipient venous system was found to be an insignificant factor with respect to venous congestion and flap survival in multivariate analysis. A history of radiation treatments was the only factor associated with a higher risk of venous compromise (odds ratio [OR] = 13.138, p < 0.001) and a lower rate of flap survival (OR = 20.182, p = 0.002).

Conclusion The selection of recipient venous systems has no impact on venous patency and flap survival. History of radiation treatment was the only factor associated with venous congestion and flap failure. Since no single method can ensure a successful reconstructive result, selecting the optimal recipient vein should be based on individual patient factors and the surgeon's experience.

 
  • References

  • 1 Urken ML, Weinberg H, Buchbinder D. , et al. Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications. Arch Otolaryngol Head Neck Surg 1994; 120 (06) 633-640
  • 2 Suh JD, Sercarz JA, Abemayor E. , et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (08) 962-966
  • 3 Chang EI, Zhang H, Liu J, Yu P, Skoracki RJ, Hanasono MM. Analysis of risk factors for flap loss and salvage in free flap head and neck reconstruction. Head Neck 2016; 38 (Suppl. 01) E771-E775
  • 4 Nahabedian MY, Singh N, Deune EG, Silverman R, Tufaro AP. Recipient vessel analysis for microvascular reconstruction of the head and neck. Ann Plast Surg 2004; 52 (02) 148-155 , discussion 156–157
  • 5 Chaput B, Vergez S, Somda S. , et al. Comparison of single and double venous anastomoses in head and neck oncologic reconstruction using free flaps: a meta-analysis. Plast Reconstr Surg 2016; 137 (05) 1583-1594
  • 6 Riot S, Herlin C, Mojallal A. , et al. A systematic review and meta-analysis of double venous anastomosis in free flaps. Plast Reconstr Surg 2015; 136 (06) 1299-1311
  • 7 Hanasono MM, Kocak E, Ogunleye O, Hartley CJ, Miller MJ. One versus two venous anastomoses in microvascular free flap surgery. Plast Reconstr Surg 2010; 126 (05) 1548-1557
  • 8 Futran ND, Stack Jr BC. Single versus dual venous drainage of the radial forearm free flap. Am J Otolaryngol 1996; 17 (02) 112-117
  • 9 Bartlett EL, Zavlin D, Menn ZK, Spiegel AJ. Algorithmic approach for intraoperative salvage of venous congestion in DIEP flaps. J Reconstr Microsurg 2018; 34 (06) 404-412
  • 10 Ehrl D, Heidekrueger PI, Heine-Geldern A, Ninkovic M, Broer PN. One versus two venous anastomoses in microvascular upper extremity reconstruction. J Reconstr Microsurg 2017; 33 (07) 502-508
  • 11 Dornseifer U, Kleeberger C, Kimelman M. , et al. Less Is More? impact of single venous anastomosis on the intrinsic transit time of free flaps. J Reconstr Microsurg 2017; 33 (02) 137-142
  • 12 Ahmadi I, Herle P, Rozen WM, Leong J. One versus two venous anastomoses in microsurgical free flaps: a meta-analysis. J Reconstr Microsurg 2014; 30 (06) 413-418
  • 13 Shima H, von Luedinghausen M, Ohno K, Michi K. Anatomy of microvascular anastomosis in the neck. Plast Reconstr Surg 1998; 101 (01) 33-41
  • 14 Deslaugiers B, Vaysse P, Combes JM. , et al. Contribution to the study of the tributaries and the termination of the external jugular vein. Surg Radiol Anat 1994; 16 (02) 173-177
  • 15 Ibrahim AE, Adelman DM, Parham C. , et al. The external jugular vein used as recipient vessel in head and neck free flap reconstruction: outcomes compared to the internal jugular vein. J Craniofac Surg 2019; 30 (01) 178-183
  • 16 Hong P, Taylor SM, Trites JR, Maclean J, Hart RD. Use of the external jugular vein as the sole recipient vein in head and neck free flap reconstruction. J Otolaryngol 2006; 35 (06) 361-365
  • 17 Francis DO, Stern RE, Zeitler D, Izzard M, Futran ND. Analysis of free flap viability based on recipient vein selection. Head Neck 2009; 31 (10) 1354-1359
  • 18 Ross GL, Ang ES, Golger A. , et al. Which venous system to choose for anastomosis in head and neck reconstructions?. Ann Plast Surg 2008; 61 (04) 396-398
  • 19 Chalian AA, Anderson TD, Weinstein GS, Weber RS. Internal jugular vein versus external jugular vein anastomosis: implications for successful free tissue transfer. Head Neck 2001; 23 (06) 475-478
  • 20 Fukuiwa T, Nishimoto K, Hayashi T, Kurono Y. Venous thrombosis after microvascular free-tissue transfer in head and neck cancer reconstruction. Auris Nasus Larynx 2008; 35 (03) 390-396
  • 21 Webster RS, Chem RC. Is the recipient vein really the main concern? A cohort study of head and neck reconstruction. Microsurgery 2009; 29 (08) 603-608
  • 22 Wax MK, Quraishi H, Rodman S, Granke K. Internal jugular vein patency in patients undergoing microvascular reconstruction. Laryngoscope 1997; 107 (09) 1245-1248
  • 23 Fisher CB, Mattox DE, Zinreich JS. Patency of the internal jugular vein after functional neck dissection. Laryngoscope 1988; 98 (09) 923-927
  • 24 Brown DH, Mulholland S, Yoo JH. , et al. Internal jugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction. Head Neck 1998; 20 (02) 169-174
  • 25 Yagi S, Suyama Y, Fukuoka K, Takeuchi H, Kitano H. Recipient vessel selection in head and neck reconstruction based on the type of neck dissection. Yonago Acta Med 2016; 59 (02) 159-162
  • 26 Shih HS, Hsieh CH, Feng GM, Feng WJ, Jeng SF. An alternative option to overcome difficult venous return in head and neck free flap reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (09) 1243-1247
  • 27 Reiter M, Baumeister P. Venous anastomosis in free flap reconstruction after radical neck dissection: is the external jugular vein a feasible option?. Eur Arch Otorhinolaryngol 2017; 274 (05) 2239-2244
  • 28 Albertengo JB, Rodriguez A, Buncke HJ, Hall EJ. A comparative study of flap survival rates in end-to-end and end-to-side microvascular anastomosis. Plast Reconstr Surg 1981; 67 (02) 194-199
  • 29 Ichinose A, Tahara S, Yokoo S. , et al. Fail-safe drainage procedure in free radial forearm flap transfer. Journal of reconstructive microsurgery 2003; 19 (06) 371-376
  • 30 Kubo T, Haramoto U, Yano K. , et al. Internal jugular vein occlusion in head and neck microsurgical reconstruction. Annals of plastic surgery 2002; 49 (05) 490-494