Summary: Free tissue transfer has been frequently used in head and neck reconstruction. However, vascular problems still cause serious damage to patients when thromboses occur in microvascular anastomoses. In the Gemini anastomosis procedure, two flap pedicle veins are anastomosed adjacently to the internal jugular vein using the end-to-side anastomosis method. From April 2019 to March 2021, 12 patients whose free flaps had two pedicle veins underwent head and neck surgery in Saitama Cancer Center (Saitama, Japan). In six patients, the veins were anastomosed adjacently to the internal jugular vein using the Gemini procedure (Gemini group). In the other six patients, the veins were anastomosed to the internal jugular vein using the end-to-side anastomosis method at a distance from each other (control group). The anastomosis time was measured retrospectively by reviewing video from the operations and comparing them across groups. There were no reoperations in any patients, and all flaps survived without exhibiting any circulatory problems. The mean total anastomosis time in the Gemini group was 21 minutes 38 seconds ± 75 seconds. The mean total anastomosis time in the control group was 34 minutes 14 seconds ± 121 seconds. The mean flap ischemic time in the Gemini group was 124 minutes ± 3 minutes. The mean flap ischemic time in the control group was 135 minutes ± 6 minutes. The Gemini anastomosis procedure is effective and convenient when the pedicle has two veins and the recipient vein choice is only the internal jugular vein in head and neck reconstruction.

We demonstrated local intravenous heparin infusion to salvage flaps after reexploration for postoperative venous congestion after free-flap breast reconstruction. All flaps were salvaged using local intravenous heparin infusion without major complications. Local intravenous heparin infusion is an effective and safe procedure.

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