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End-to-Side Venous Anastomosis to a Ligated Vein Stump for Free Flap Transfer in Head and Neck Reconstruction

Akazawa, Toshifumi MD*; Sekido, Mitsuru MD*; Adachi, Koji MD*; Sasaki, Kaoru MD*; Aihara, Yukiko MD*; Shibuya, Yoichiro MD*; Makino, Syujiro DDS

doi: 10.1097/SAP.0000000000001905

Introduction In head and neck reconstruction, use of a free flap paired with end-to-side anastomosis to a preserved vein is generally performed. However, it is frequently difficult to select the recipient vein after a neck dissection in which there is only a ligated internal jugular vein/external jugular vein (IJV/EJV). Here, a new anastomosis technique using a ligated IJV/EJV stump is described.

Patients and Methods End-to-side anastomoses to ligated vein stump surgeries for free flap transfer in head and neck reconstruction were performed at the Department of Plastic and Reconstructive Surgery, University of Tsukuba, from 2009 to 2016.

Results The subject pool comprised 6 patients. All patients received a free flap transfer after head and neck tumor excision. The free flaps used were 1 free radial forearm flap, 1 free tensor fascia lata muscle perforator flap, and 4 free rectus abdominis musculocutaneous flaps. The cervical vessels used were 3 IJVs and 3 EJVs. All veins of the free flaps could be anastomosed end-to-side to ligated vein stumps without vein grafting. All flaps survived completely without complications.

Conclusions The end-to-side venous anastomosis to a ligated vein stump procedures were easy to perform and not dependent on the vessel diameters of the free flaps. No complications were observed in any patient owing to differences in vessel diameter, ease of anastomosis, and safety. Results suggest that this new technique is a simple and very useful option in head and neck reconstruction where the IJV/EJV cannot be preserved.

From the *Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki; and

Department of Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido, Japan.

Received July 1, 2018, and accepted for publication, after revision January 29, 2019.

Conflicts of interest and sources of funding: The authors have no financial interest to declare in relation to the content of this article. The authors declare no conflict of interest.

Reprints: Toshifumi Akazawa, MD, Department of Plastic and Reconstructive Surgery, Faculty of Medicine University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan. E-mail:

Online date: June 20, 2019

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