Is the recipient vein really the main concern? A cohort study of head and neck reconstruction

Abstract

The aim of this study was to verify the role of the venous drainage system in the pathogenesis of complications in microsurgical head and neck reconstruction. In a nonrandomized cohort study, 52 consecutive cases of complex head and neck microsurgical reconstruction were evaluated. The patients were divided in two groups based on the treatment: the deep (DVDG; n = 30) and superficial (SVDG; n = 22) venous drainage groups. The complications evaluated included vascular obstruction with partial or total loss of the microsurgical flap, inadequate healing (fistulas or suture dehiscence), and infections. The arterial anastomotic site, neoplastic recurrence, use of medications and neoadjuvant radiotherapy, flap selection, tumor histology, smoking/alcoholism, and systemic diseases had no effect on postoperative complications, while the venous component influenced the overall complication rate (chi-square test, P = 0.006). A protective effect was achieved in the DVDG when the overall complication rate was considered--relative risk (RR) 0.65, 95% confidence interval (CI) 0.45-0.94. The recipient vein should be the surgeon's main concern as it influenced the outcomes of patients undergoing complex microsurgical head and neck reconstruction. A protective effect was observed when the internal jugular vein drainage system was used for this purpose.

The effect of smoking on perioperative complications in head and neck oncologic surgery

“…Eleven articles on microvascular procedures suggested an association between smoking and perioperative complications (Table III), [26][27][28][29][30][31][32][33][34][35][36] whereas six did not (Table IV). [37][38][39][40][41][42] Four articles showed mixed results, meaning that some analyses showed increased complications related to tobacco and some did not (Tables III and IV). [43][44][45][46] In addition, one article by Moore and colleagues evaluated the effects of smoking on regional head and neck reconstruction via cervicofacial and cervicothoracic rotation flaps after oncologic resection.…”

Internal jugular vein duplication: clinical significance for head and neck cancer ablative and reconstructive surgery

“…The strategic location of the IJV makes it an important anatomical landmark for ND [ 3 ]. Moreover, in H&N operations involving reconstruction with free flaps, the IJV and its tributaries provide the recipient veins used for microvascular anastomosis [ 11 ].…”

“…The importance of the IJV is further heightened in H&N cancer cases that require reconstruction with free tissue transfer as the IJV itself (end-to-side anastomosis) or its tributaries (end-to-end anastomosis) are the most common recipient vessels for the venous anastomosis of the free flap [ 3 ].…”

Impact of Recipient Vein Selection on Venous Patency and Free Flap Survival in 652 Head and Neck Reconstructions

“…15 Most authors reported that each system is equally reliable, 4,[15][16][17][18] while other studies supported that IJVS is the ideal recipient if technically feasible. [19][20][21] Although debates over which system is more adequate are currently in progress (summarized in ►Table 3), each system has its own advantages and disadvantages. The IJVS provides a wide range of choices with its multiple branches and has merits in facilitating venous flow by negative intrathoracic pressure during inspiration.…”