title: Which venous system to choose for anastomosis in head and neck reconstructions?
abstract: It has been postulated that venous thrombosis in free flap surgery necessitates the use of 2 venous anastomoses into different venous systems. We retrospectively analyzed a single surgeon's 10-year experience (August 1993 to August 2003) in primary free flap reconstruction for malignant tumors of the head and neck. Of 492 primary reconstructions that did not need a vein graft, vein loop, or cephalic turnover procedure, 251 used the internal jugular venous system as venous outflow, 140 used the subclavian system as outflow, and 101 used both. Two hundred thirty-eight of 251 (95%) of flaps utilizing the internal jugular venous system for outflow were successful compared with 129 of 140 (92%) of flaps utilizing the subclavian system. Where both venous systems were used the success rate was 101 of 101 (100%) (P < 0.05). Where possible, a second venous anastomosis should be performed utilizing both venous drainage systems.
authors.affiliation: Department of Head and Neck Surgery, Toronto General Hospital, Toronto, Canada. gary.ross@christie.nhs.uk
authors.forename: Gary L
authors.initials: GL
authors.lastname: Ross
authors.forename: Erik S W
authors.initials: ES
authors.lastname: Ang
authors.forename: Alex
authors.initials: A
authors.lastname: Golger
authors.forename: Declan
authors.initials: D
authors.lastname: Lannon
authors.forename: Patrick
authors.initials: P
authors.lastname: Addison
authors.forename: Laura
authors.initials: L
authors.lastname: Snell
authors.forename: Christine B
authors.initials: CB
authors.lastname: Novak
authors.forename: Joan E
authors.initials: JE
authors.lastname: Lipa
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome