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.
Resumen
An old controversy revisited-one versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap.
Por qué esto importa para la hirudoterapia
Esta serie retrospectiva de un solo cirujano de 315 reconstrucciones de cabeza y cuello con colgajo libre anterolateral del muslo comparó una versus dos anastomosis venosas, y encontró que los colgajos con una sola anastomosis venosa requirieron reintervenciones con más frecuencia (19% vs 10.8%) y, una vez que se desarrolló la congestión venosa, tenían muchas más probabilidades de necesitar rescate quirúrgico por insuficiencia venosa (35.5% vs 6.3%), sin diferencias en la supervivencia global del colgajo. Esto es importante para la hirudoterapia porque la congestión venosa de los colgajos libres es precisamente el escenario clínico en el que se usan las sanguijuelas medicinales de forma adyuvante para descomprimir un colgajo comprometido; el estudio cuantifica la vulnerabilidad de los colgajos con un solo flujo de salida a exactamente esa complicación. A modo de advertencia honesta, este es un estudio observacional retrospectivo sobre la técnica anastomótica que no estudia la terapia con sanguijuelas en sí, por lo que solo enmarca la población en riesgo en lugar de proporcionar evidencia directa para la aplicación de sanguijuelas.
Citación
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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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026