title: Revisiting the argument for 1- versus 2-vein outflow in head and neck free tissue transfers: A review of 317 microvascular reconstructions.
abstract: The purpose of this study was to determine the benefit of 1-vein versus 2-vein outflow in microvascular free tissue transfers.
  
  
  
  A retrospective review reflects the experience of 6 surgeons. Analysis included all patients who underwent reconstruction at a single institution between January 2004 and December 2012.
  
  
  
  Three hundred nine patients underwent a total of 317 microvascular free flap reconstructions for head and neck defects. Two hundred thirteen of 317 flaps (67.2%) used 1 venous anastomosis and 104 (32.8%) used 2 venous anastomoses. Venous congestion necessitated urgent take back in 37 of 57 patients (64.9%) requiring exploration for perioperative complications. Thirty of 37 flaps (81.1%) with venous congestion had 1 vein anastomosis, whereas 7 (18.9%) had dual vein outflow (p = .03). Overall flap success was 303 of 317 (95.6%), despite an 18.0% (57 of 317) perioperative take back rate.
  
  
  
  Coapting 2 veins was shown to minimize venous congestion. © 2015 Wiley Periodicals, Inc. Head Neck 38: 820-823, 2016.
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: Silverman
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Wojciech H
authors.initials: WH
authors.lastname: Przylecki
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Arganbright
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Yelizaveta
authors.initials: Y
authors.lastname: Shnayder
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Kiran
authors.initials: K
authors.lastname: Kakarala
authors.affiliation: Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Niaman
authors.initials: N
authors.lastname: Nazir
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Terance T
authors.initials: TT
authors.lastname: Tsue
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Girod
authors.affiliation: Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas.|Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006257:Head / Q000601:surgery*; D006801:Humans; D006940:Hyperemia; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014680:Veins / Q000637:transplantation*; D055815:Young Adult
keywords: dual vein outflow; free flap reconstruction; free tissue transfer; vascular compromise; venous congestion