title: One versus two venous anastomoses in microvascular lower extremity reconstruction using gracilis muscle or anterolateral thigh flaps.
abstract: BACKGROUND
  Free tissue transfers are a highly reliable procedure routinely performed for reconstruction of a wide range of defects. Main complication in free flap surgery is usually venous thrombosis. Many technical controversies exist regarding the technical details of the microvascular anastomosis in order to prevent occurrence of thrombosis and optimize outcomes. We therefore evaluated our results regarding the execution of one versus two venous anastomoses in a variety of free flaps (fasciocutaneous- or muscle free flap) utilized for lower limb reconstruction.
  
  
  METHODS
  Between 2009 and 2015, 354 patients underwent 386 free ALT- or gracilis flaps for lower limb defect reconstruction after trauma, infection, or malignancies at our institution. The data was retrospectively screened for patients' demographics, perioperative details, flap survival, and surgical complications. The cases were divided into two groups regarding the number of microsurgically performed venous anastomosis: one versus two veins.
  
  
  RESULTS
  Regarding the preoperative evaluation, there were no significant differences regarding comorbidities between the two groups. Overall, there was no significant difference regarding the rate of major (1 vein: 20.38% versus 2 veins: 18.78%, p>0.05) and minor (1 vein: 1.27% versus 2 veins: 2.18%, p>0.05) surgical complications during our 3-months follow-up period. Major complications included total flap losses of 5.73% (1 vein) versus 8.78% (2 veins).
  
  
  CONCLUSIONS
  This study analyzed a large series of microsurgical reconstructions, with a focus on the impact of the number of venous anastomosis. The findings suggest that successful free tissue transfer for lower limb reconstruction can be achieved independent of the number of venous anastomoses, however two should be performed when technically feasible.
authors: Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany. Electronic address: paul@heidekrueger.net.
authors: Paul I
authors: PI
authors: Heidekrueger
authors: Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany.
authors: Denis
authors: D
authors: Ehrl
authors: Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany.
authors: Albrecht
authors: A
authors: Heine-Geldern
authors: Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany.
authors: Milomir
authors: M
authors: Ninkovic
authors: Department of Plastic, Reconstructive, Hand and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Germany.
authors: P Niclas
authors: PN
authors: Broer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D000071976:Gracilis Muscle / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013848:Thigh; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Free flap reconstruction; Lower limb reconstruction; Microsurgery; Microvascular anastomosis; Venous anastomosis