title: Characteristics and surgical management of flap compromise caused by thrombosis of the internal jugular vein.
abstract: BACKGROUND
  A principal reason for flap compromise in oral and maxillofacial head and neck surgery, and failure of a free flap transfer, is thrombosis of a drainage vein such as the internal jugular vein. This study characterized flap compromise caused by internal jugular vein thrombosis after a free flap transfer, and its management.
  
  
  METHODS
  A retrospective clinical study was conducted of 306 consecutive microvascular free flaps performed for 305 patients with head and neck cancer from March 2003 to March 2013 at the Department of Oral and Maxillofacial Surgery at Beijing Stomatological Hospital, Capital Medical University.
  
  
  RESULTS
  Vascular thrombosis developed postoperatively in 18 of the 306 free flaps (5.9%): 1 arterial and 17 venous. Of the latter, in 10 patients the thrombosis occurred at the anastomosis site; in 7 patients internal jugular vein thrombosis was detected during emergent reexploration (4 radial forearm free flaps, 1 fibular flap, and 2 anterior lateral thigh flaps). The 4 cases involving radial forearm free flaps were salvaged successfully by venous transfer to bridge the reflow vein to the anterior jugular vein, or removal of the thrombosis in the internal jugular vein and re-anastomosis. The remaining 3 cases of internal jugular vein thrombosis were not salvaged: 2 defects were reconstructed with major pectoralis myocutaneous flaps, and the other was closed directly without reconstruction.
  
  
  CONCLUSIONS
  In oral and maxillofacial head and neck cancer surgery, postoperative thrombosis of the internal jugular vein can result in failure of the free flap transfer.
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Su
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Jinzhong
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
authors.forename: Rudong
authors.initials: R
authors.lastname: Xing
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China. Electronic address: hanf1989@hotmail.com.
authors.forename: Zhengxue
authors.initials: Z
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000098:blood supply* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*
keywords: Flap compromise; Internal jugular vein; Thrombosis