Back to Search Start Over

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

Authors :
Benjamin Vairel
Jean Louis Grolleau
Guillaume de Bonnecaze
Sébastien Vergez
Samuel Riot
Thomas Meresse
Benoit Chaput
Serge M. A. Somda
Ignacio Garrido
Ali Mojallal
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.

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