title: Do multiple venous anastomoses reduce risk of thrombosis in free-flap transfer? Efficacy of dual anastomoses of separate venous systems.
abstract: Whether or not multiple venous anastomoses reduce the risk of free-flap failure is a subject of controversy. We report here, for the first time, on the importance of selecting 2 separate venous systems of the flap for dual anastomoses. The efficacy of multiple anastomoses was verified through a retrospective review of 310 cases of the free radial forearm flap transfer. Dual anastomoses of separate venous systems (the superficial and the deep) showed a lower incidence of venous insufficiency than single anastomosis did (0.7% versus 7.5%; P < 0.05). On the other hand, dual anastomoses of a sole venous system showed no significant difference in the incidence of venous insufficiency compared with single anastomosis (11.5% versus 7.5%; P = 0.48). Our results suggest that dual venous anastomoses of separate venous systems is conducive to reduced risk of flap failure and affords protection against venous catastrophe through a self-compensating mechanism that obviates thrombosis of either anastomosis.
authors.affiliation: Department of Plastic Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ichinose
authors.forename: Hiroto
authors.initials: H
authors.lastname: Terashi
authors.forename: Minoru
authors.initials: M
authors.lastname: Nakahara
authors.forename: Isao
authors.initials: I
authors.lastname: Sugimoto
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Hashikawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nomura
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Ogata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokoo
authors.forename: Shinya
authors.initials: S
authors.lastname: Tahara
mesh_terms: D001163:Arteriovenous Anastomosis; D016009:Chi-Square Distribution; D005260:Female; D005542:Forearm / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000453:epidemiology / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology