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Comparison of Single and Double Venous Anastomoses in Head and Neck Oncologic Reconstruction Using Free Flaps
Comparison of Single and Double Venous Anastomoses in Head and Neck Oncologic Reconstruction Using Free Flaps
- Source :
- Plastic and Reconstructive Surgery. 137:1583-1594
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- 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; p0.001).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.
- Subjects :
- Microsurgery
medicine.medical_specialty
medicine.medical_treatment
MEDLINE
Surgical Revision
030230 surgery
Anastomosis
Free Tissue Flaps
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
medicine
Humans
Head and neck
Venous Thrombosis
business.industry
Anastomosis, Surgical
Plastic Surgery Procedures
Surgery
Treatment Outcome
Venous Insufficiency
Head and Neck Neoplasms
030220 oncology & carcinogenesis
Meta-analysis
Venous anastomosis
Free flap surgery
business
Vascular Surgical Procedures
Subjects
Details
- ISSN :
- 00321052
- Volume :
- 137
- Database :
- OpenAIRE
- Journal :
- Plastic and Reconstructive Surgery
- Accession number :
- edsair.doi.dedup.....c098508acc192f102ca7e098065c2a4d
- Full Text :
- https://doi.org/10.1097/prs.0000000000002087