Which venous system to choose for anastomosis in head and neck reconstructions?

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.

Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis?

BACKGROUND: Successful free flap surgery in the head and neck is dependent on the successful anastomosis of both artery and vein. The success of all free flaps was analyzed to determine the necessity for performing 2 venous anastomoses. METHODS: We retrospectively analyzed a single surgeon's 10-year experience (August 1993-August 2003) in free flap reconstruction for malignant tumors of the head and neck. Four hundred ninety-two free flaps were primary reconstructions that did not require a vein graft, vein loop, or cephalic turnover procedure. Three hundred forty-five flaps had 1 venous anastomosis, and 147 flaps had 2 venous anastomoses. RESULTS: Overall, flap success was 468 of 492 (95.1%). Successful flap reconstruction in patients undergoing 2 venous anastomoses was 145 of 147 (98.6%) compared with 323 of 345 (93.6%) in patients undergoing 1 anastomosis (p < .05). CONCLUSION: Where possible, a second venous anastomosis should be performed in head and neck free flap reconstruction.

2-Octylcynanoacrylate-assisted microvascular anastomosis in a rat model: long-term biomechanical properties and histological changes.

The aim of this study was to establish the long-term biomechanical and histological properties of 2-octylcyanoacrylate-assisted microvascular anastomosis over conventional suture-only anastomosis in the laboratory rat model. The biomechanical and histological properties of three groups of vessels were compared: 1) vessels with 2-octylcyanoacrylate-assisted anastomoses (study group); 2) vessels with suture-only anastomoses (control group); and 3) normal unoperated vessels (sham group). In total, 144 adult rats were used, and these were studied at 1 week, 1 month, 3 months, and 6 months postanastomosis. At 6 months, the tensile strength of study vessels was significantly higher than control vessels. The stiffness of study and control vessels was similar at all time intervals. Histologically, there was no evidence that 2- octylcyanoacrylate caused toxicity to vessel walls, and there was less perivasacular foreign-body giant-cell reaction in the study group compared to the control group. Long-term follow-up showed that microvascular anastomosis with 2-octylcyanoacrylate in rat femoral arteries had superior tensile strength and similar stiffness to vessels anastomosed with sutures only, without adverse effects to surrounding tissues.