Comparison of Single and Double Venous Anastomoses in Head and Neck Oncologic Reconstruction Using Free Flaps: A Meta-Analysis.
Venous insufficiency is the main cause of failure and surgical revision in free flap surgery. Achieving a double venous anastomosis is frequently proposed to improve flap drainage. However, this procedure remains controversial. The authors evaluated, through a meta-analysis, the benefit of double venous anastomoses in the venous thrombosis, surgical revision, and failure rates of free flaps in head and neck oncologic reconstruction.



A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria in the MEDLINE, PubMed Central, Cochrane Library, and EMBASE databases. Statistical heterogeneity evaluation and then fixed effects and random effects models were used.



Sixteen articles were included involving 3684 flaps. The overall success rate was 96.15 percent. The authors reported a failure rate of 1.51 percent in the group with two anastomoses versus 5.03 percent in the group with single anastomoses (OR, 0.64; 95 percent CI, 0.277 to 1.522; p = 0.320). The authors found a venous thrombosis rate of 2.74 percent in the group with two anastomoses versus 4.54 percent in the group with single anastomoses (OR, 0.535; 95 percent CI, 0.334 to 0.858; p = 0.009). There were also more surgical revisions in the single venous anastomoses group, 11.87 percent versus 6.04 percent (OR, 0.474; 95 percent CI, 0.349 to 0.643; p < 0.001).



This meta-analysis supports that performing a double venous anastomosis confers protective effects in venous thrombosis and surgical revision, thus reducing free flap failure. The authors recommend the achievement of double venous anastomosis whenever it is feasible in head and neck oncologic reconstruction.



Therapeutic, IV.
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Benoit
B
Chaput
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Sebastien
S
Vergez
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Serge
S
Somda
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Ali
A
Mojallal
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Samuel
S
Riot
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Benjamin
B
Vairel
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Thomas
T
Meresse
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Ignacio
I
Garrido
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Jean Louis
JL
Grolleau
Toulouse and Lyon, France.|From the Departments of Plastic Reconstructive Surgery and Burns and Otolaryngology, University of Toulouse, CHU Rangueil-Larrey; the Department of Otolaryngology, Head and Neck Surgery, and the Biostatistic Unit, Cancer University Institute of Toulouse Oncopole; and the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital.
Guillaume
G
de Bonnecaze
D000714:Anastomosis, Surgical; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008866:Microsurgery; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control