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Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity

Vessel Selection In Lieu of Obligatory Number

Mattos, David MD, MBA*; Diamond, Shawn MD*; Chattha, Anmol S. BA*; Riesel, Johanna N. MD*; Iorio, Matthew L. MD*†

doi: 10.1097/SAP.0000000000001431
Microsurgery: PDF Only

Background Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer.

Methods All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed. An algorithm was used to determine the type and number of venous anastomoses, emphasizing patient anatomy, venous quality, and size match. Patients were divided into single- and dual-venous-anastomosis groups. Univariate analysis determined differences between the groups. A multivariable analysis identified independent risk factors.

Results Fifty patients met the inclusion criteria. Patient demographics, recipient sites, wound type, and flap characteristics were similar in 1 and 2 vein groups. Average follow-up was 9.6 months. Forty-two percent underwent single venous drainage anastomoses. Mean age was 52.7 years, 78.0% were male, and 60% had defects of the foot and ankle. Increased flap area and early dangling did not increase flap demise. Thirty-three percent of single-drainage patients and 31.0% of dual-drainage patients had a complication. A body mass index of greater than 30 kg/m2 was a predictor for both flap complication (P = 0.025) and partial flap loss (P = 0.031) in univariate analysis. No independent predictors were found in multivariate analysis.

Conclusions The number of venous anastomoses, area, and dangling protocol did not influence outcomes while using our lower extremity vein method. Thoughtful evaluation of venous egress should outweigh the routine use of multiple veins in perforator flap reconstructions of the lower extremity.

From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, and

Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Received November 29, 2017, and accepted for publication, after revision January 29, 2018.

Conflicts of interest and sources of funding: The authors did not receive any funding for this study. None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article. There are also no commercial associations.

Presented at: The Northeastern Society of Plastic Surgeons annual meeting in Newport, RI, in 2017.

Reprints: Matthew L. Iorio, MD, Department of Surgery, Plastic and Reconstructive Surgery, University of Colorado Medical Center, Mail Stop C309, 12631 East 17th Ave, Room 6619, Aurora, CO 80045. E-mail:

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