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One versus Two Venous Anastomoses in Microvascular Free Flap Surgery

Hanasono, Matthew M. M.D.; Kocak, Ergun M.D.; Ogunleye, Olubunmi M.D.; Hartley, Craig J. Ph.D.; Miller, Michael J. M.D.

Plastic and Reconstructive Surgery: November 2010 - Volume 126 - Issue 5 - p 1548-1557
doi: 10.1097/PRS.0b013e3181ef8c9f
Reconstructive: Head and Neck: Original Articles

Background: The authors' goal was to determine whether one or two venous anastomoses results in superior blood flow through microvascular free flaps.

Methods: During flap harvest, blood velocity was measured in each of two venae comitantes using Doppler ultrasonography. Next, one of the two veins was occluded with a microvascular clamp and blood velocity was measured in the open vein. The clamp was then removed and placed on the other vein, and blood velocity was measured in the first vein. The pedicle was divided and microvascular anastomosis of either one or two veins was performed. Venous blood velocity was then compared between flaps with one versus two venous anastomoses.

Results: Eighty-one free flaps were performed. Before pedicle division, the peak venous blood velocity in each of the two venae comitantes averaged 6.3 ± 4.8 cm/second. When one of the veins was occluded, the peak venous blood velocity increased to 19.5 ± 17.3 cm/second (p < 0.00001). One venous anastomosis was performed in 69 flaps and two venous anastomoses were performed in 12 flaps. The mean blood velocity in flaps in which one venous anastomosis was performed was greater than the mean blood velocity in either vein when two venous anastomoses were performed (13.1 ± 7.3 cm/second versus 7.5 ± 4.3 cm/second, respectively; p = 0.001).

Conclusions: When one vena comitans is occluded, blood velocity in the second vena comitans increases significantly. Venous blood velocity is significantly greater after a single venous anastomosis than in either of two veins when two venous anastomoses are performed. These results argue against routinely performing two venous anastomoses.

Houston, Texas; and Columbus, Ohio

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center; Department of Medicine, Section of Cardiovascular Sciences, Baylor College of Medicine; and Division of Plastic Surgery, The Ohio State University College of Medicine.

Received for publication January 5, 2010; accepted May 6, 2010.

Presented at the 54th Annual Meeting of the Plastic Surgery Research Council, in Pittsburgh, Pennsylvania, May 27 through 30, 2009.

Disclosure:The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Matthew M. Hanasono, M.D., Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 443, Houston, Texas 77030, mhanasono@mdanderson.org

©2010American Society of Plastic Surgeons