An old controversy revisited-one versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap.
Research article published in Microsurgery (2014)
Abstract
BACKGROUND: The necessity of a second venous anastomosis in free tissue transfer is controversial. We review a single surgeon's 8-year experience of head and neck reconstruction using free anterolateral flap reconstruction to assess the need for a second venous anastomosis. PATIENTS AND METHOD: Three hundred and fifteen cases were included in the study after selecting only for anterolateral thigh flap, head, and neck reconstruction, and those that used superior thyroid artery as recipient. The selection criteria were designed to create as homogeneous a group as possible to decrease confounding factors. RESULTS: The group with single anastomosis required more frequent take-backs than the group with dual anastomoses (19% vs 10.8%, P = 0.055). The trend persisted when only take-backs for venous insufficiencies were compared (8.2% vs 2.5%, P = 0.039). When flaps with single anastomosis developed venous congestion, they were more likely to require operative salvage for venous insufficiency than those with dual anastomoses (35.5% vs. 6.3%, P = 0.037). No difference was found in postoperative complications and flap survival. CONCLUSION: Our data suggest that flaps with single venous anastomosis are more likely to require take-back for flap salvage than those with dual anastomoses.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
An old controversy revisited-one versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap.
Why This Matters for Hirudotherapy
This retrospective single-surgeon series of 315 anterolateral thigh free-flap head and neck reconstructions compared one versus two venous anastomoses, and found that flaps with a single venous anastomosis required take-backs more often (19% vs 10.8%) and, once venous congestion developed, were far more likely to need operative salvage for venous insufficiency (35.5% vs 6.3%), with no difference in overall flap survival. This matters to hirudotherapy because venous congestion of free flaps is precisely the clinical setting in which medicinal leeches are used adjunctively to decompress a struggling flap; the study quantifies how vulnerable single-outflow flaps are to exactly that complication. As an honest caveat, this is a retrospective observational study about anastomotic technique that does not study leech therapy itself, so it only frames the at-risk population rather than providing any direct evidence for leeching.
Citation
An old controversy revisited-one versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap.
Chen et al. · Microsurgery, 2014
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