An old controversy revisited - One versus two venous anastomoses in microvascular head and neck reconstruction using anterolateral thigh flap

Background The necessity of a second venous anastomosis in free tissue transfer is controversial. We review a single surgeon's 8-year experience of head and neck reconstruction using free anterolateral flap reconstruction to assess the need for a second venous anastomosis. Patients and method Three hundred and fifteen cases were included in the study after selecting only for anterolateral thigh flap, head, and neck reconstruction, and those that used superior thyroid artery as recipient. The selection criteria were designed to create as homogeneous a group as possible to decrease confounding factors. Results The group with single anastomosis required more frequent take-backs than the group with dual anastomoses (19% vs 10.8%, P=0.055). The trend persisted when only take-backs for venous insufficiencies were compared (8.2% vs 2.5%, P=0.039). When flaps with single anastomosis developed venous congestion, they were more likely to require operative salvage for venous insufficiency than those with dual anastomoses (35.5% vs. 6.3%, P=0.037). No difference was found in postoperative complications and flap survival. Conclusion Our data suggest that flaps with single venous anastomosis are more likely to require take-back for flap salvage than those with dual anastomoses.