Do Multiple Venous Anastomoses Reduce Risk of Thrombosis in Free-Flap Transfer?

In Brief Whether or not multiple venous anastomoses reduce the risk of free-flap failure is a subject of controversy. We report here, for the first time, on the importance of selecting 2 separate venous systems of the flap for dual anastomoses. The efficacy of multiple anastomoses was verified through a retrospective review of 310 cases of the free radial forearm flap transfer. Dual anastomoses of separate venous systems (the superficial and the deep) showed a lower incidence of venous insufficiency than single anastomosis did (0.7% versus 7.5%; P < 0.05). On the other hand, dual anastomoses of a sole venous system showed no significant difference in the incidence of venous insufficiency compared with single anastomosis (11.5% versus 7.5%; P = 0.48). Our results suggest that dual venous anastomoses of separate venous systems is conducive to reduced risk of flap failure and affords protection against venous catastrophe through a self-compensating mechanism that obviates thrombosis of either anastomosis. A retrospective review of 310 free radial forearm flap transfers demonstrated a lower incidence of venous insufficiency when both superficial and deep systems were anastomosed (0.7%) compared to a single anastomosis (7.5%). However, no such improvement in result was seen when dual anastomoses were to veins of the same system (11.5% vs 7.5%).