Download PDF
J Reconstr Microsurg 2017; 33(07): 502-508
DOI: 10.1055/s-0037-1602759
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

One versus Two Venous Anastomoses in Microvascular Upper Extremity Reconstruction

Denis Ehrl
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
*   Both the authors have contributed equally to this article.
,
Paul I. Heidekrueger
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
*   Both the authors have contributed equally to this article.
,
Albrecht Heine-Geldern
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
,
Milomir Ninkovic
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
,
P. Niclas Broer
1   Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM – Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany
› Author Affiliations
Further Information

Publication History

27 November 2016

23 March 2017

Publication Date:
04 May 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Background Free tissue transfers are routinely performed for reconstruction of the upper limb. Main complication in free flap surgery still stems from vascular compromise and many technical controversies exist regarding the technical details of how to perform the microvascular anastomosis. This study evaluates outcomes regarding the execution of one versus two venous anastomoses for upper limb reconstruction.

Methods In this study, 79 patients underwent 86 free anterolateral thigh (ALT) or groin flaps for upper limb reconstruction after trauma, infection, or malignancies. The data were retrospectively screened for patients' demographics, perioperative details, flap survival, and surgical complications. The cases were divided into two groups regarding the number of performed venous anastomoses: one versus two veins.

Results No significant differences existed between the two groups regarding preoperative comorbidities (ALT: 16 one, 21 two veins; groin: 16 one, 33 two veins). Overall, there was no significant difference regarding the rate of major (1 vein: 18.8% vs. 2 veins: 20.4%; p > 0.05) and minor (1 vein: 3.1% vs. 2 veins: 3.7%; p > 0.05) surgical complications during the 3-month follow-up period. Major complications included total flap losses of 9.4% (1 vein) versus 7.4% (2 veins) (p > 0.05).

Conclusion This study analyzed a series of microsurgical reconstructions with a focus on the impact of the number of performed venous anastomoses. The findings suggest that successful free tissue transfer for upper limb reconstruction can be achieved independent of the number of venous anastomoses. However, to promote additional safety, a second vein should be performed whenever technically possible.

Keywords

upper limb reconstruction - free flap surgery - venous anastomosis
 

  • References

  • 1 Lin CH, Lin YT, Yeh JT, Chen CT. Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect. Plast Reconstr Surg 2007; 119 (07) 2118-2126
    CrossrefPubMedGoogle Scholar
  • 2 Lorenzo AR, Lin CH, Lin CH. , et al. Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers. J Plast Reconstr Aesthet Surg 2011; 64 (05) 649-655
    CrossrefPubMedGoogle Scholar
  • 3 Pederson WC. Upper extremity microsurgery. Plast Reconstr Surg 2001; 107 (06) 1524-1537 , discussion 1538–1539, 1540–1543
    CrossrefPubMedGoogle Scholar
  • 4 Spindler N, Al-Benna S, Ring A. , et al. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction. GMS Interdiscip Plast Reconstr Surg DGPW 2015; 4: Doc05
    PubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 Tran NV, Buchel EW, Convery PA. Microvascular complications of DIEP flaps. Plast Reconstr Surg 2007; 119 (05) 1397-1405 , discussion 1406–1408
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Khouri RK, Cooley BC, Kunselman AR. , et al. A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 1998; 102 (03) 711-721
    CrossrefPubMedGoogle Scholar
  • 9 Fernandez EJ, Nadal RD, Gonzalez SM, Caffee HH. The effect of stasis on a microvascular anastomosis. Microsurgery 1983; 4 (03) 176-177
    CrossrefPubMedGoogle Scholar
  • 10 Strecker WB, Wood MB, Schroeder AR. Stasis-induced thrombosis of rat microvascular anastomosis. J Reconstr Microsurg 1987; 4 (01) 69-73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Chen WF, Kung YP, Kang YC, Lawrence WT, Tsao CK. An old controversy revisited-one versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap. Microsurgery 2014; 34 (05) 377-383
    CrossrefPubMedGoogle Scholar
  • 12 Ichinose A, Terashi H, Nakahara M. , et al. Do multiple venous anastomoses reduce risk of thrombosis in free-flap transfer? Efficacy of dual anastomoses of separate venous systems. Ann Plast Surg 2004; 52 (01) 61-63
    CrossrefPubMedGoogle Scholar
  • 13 Ross GL, Ang ES, Lannon D. , et al. Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis?. Head Neck 2008; 30 (08) 1086-1089
    CrossrefPubMedGoogle Scholar
  • 14 Miller TJ, Jeong HS, Davis K. , et al. Evaluation of the American Society of Anesthesiologists Physical Status classification system in risk assessment for plastic and reconstructive surgery patients. Aesthet Surg J 2014; 34 (03) 448-456
    CrossrefPubMedGoogle Scholar
  • 15 Muramatsu K, Shigetomi M, Ihara K, Kawai S, Doi K. Vascular complication in free tissue transfer to the leg. Microsurgery 2001; 21 (08) 362-365
    CrossrefPubMedGoogle Scholar
  • 16 Spector JA, Levine S, Levine JP. Free tissue transfer to the lower extremity distal to the zone of injury: indications and outcomes over a 25-year experience. Plast Reconstr Surg 2007; 120 (04) 952-959
    CrossrefPubMedGoogle Scholar
  • 17 Tsai TM, Bennett DL, Pederson WC, Matiko J. Complications and vascular salvage of free-tissue transfers to the extremities. Plast Reconstr Surg 1988; 82 (06) 1022-1026
    CrossrefPubMedGoogle Scholar
  • 18 Gorman PW, Barnes CL, Fischer TJ, McAndrew MP, Moore MM. Soft-tissue reconstruction in severe lower extremity trauma. A review. Clin Orthop Relat Res 1989; (243) 57-64
    PubMedGoogle Scholar
  • 19 Grotting JC. Prevention of complications and correction of postoperative problems in microsurgery of the lower extremity. Clin Plast Surg 1991; 18 (03) 485-489
    PubMedGoogle Scholar
  • 20 Han Z, Li J, Li H, Su M, Qin L. Single versus dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction: a retrospective study. Microsurgery 2013; 33 (08) 652-655
    CrossrefPubMedGoogle Scholar
  • 21 Lee YC, Chen WC, Chen SH. , et al. One versus two venous anastomoses in anterolateral thigh flap reconstruction after oral cancer ablation. Plast Reconstr Surg 2016; 138 (02) 481-489
    CrossrefPubMedGoogle Scholar
  • 22 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Enajat M, Rozen WM, Whitaker IS, Smit JM, Acosta R. A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: investigating the effect on venous congestion and flap survival. Microsurgery 2010; 30 (03) 185-191
    CrossrefPubMedGoogle Scholar
  • 24 Futran ND, Stack Jr BC. Single versus dual venous drainage of the radial forearm free flap. Am J Otolaryngol 1996; 17 (02) 112-117
    CrossrefPubMedGoogle Scholar
  • 25 Liu Y, Jiang X, Huang J. , et al. Reliability of the superficial venous drainage of the radial forearm free flaps in oral and maxillofacial reconstruction. Microsurgery 2008; 28 (04) 243-247
    CrossrefPubMedGoogle Scholar
  • 26 Fahmy HW, Moneim MS. The effect of prolonged blood stasis on a microarterial repair. J Reconstr Microsurg 1988; 4 (02) 139-143
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Ghosh A, Jayakumar R. Free groin flap for recurrent severe contractures of the neck in children. Indian J Plast Surg 2010; 43 (Suppl): S80-S84
    CrossrefPubMedGoogle Scholar
  • 28 Matsuda K, Tomita K, Fukai M. , et al. Vein/arterial grafts harvested within the incision for a free groin flap. Plast Reconstr Surg Glob Open 2015; 3 (06) e407
    CrossrefPubMedGoogle Scholar
  • 29 Khashaba AA, McGregor IA. Haemodynamics of the radial forearm flap. Br J Plast Surg 1986; 39 (04) 441-450
    CrossrefPubMedGoogle Scholar