One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation

Lee, Yao-Chou; Chen, Wei‐Chen; Chen, Szu-Han; Hung, Kuo-Shu; Hsiao, Jenn-Ren; Lee, Jing-Wei; Shieh, Shyh‐Jou

doi:10.1097/prs.0000000000002365

Cited by 25 publications

(28 citation statements)

References 20 publications

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“…Lee et al claimed that two vein anastomoses achieved better outcomes with the anterolateral thigh flap, which is one of the workhorse flaps for head and neck reconstruction. 18 Conversely, Khaja et al proved that two vein anastomoses in head and neck free flap did not reduce flap failure rate or postoperative venous thrombosis. 19 In this study, the number of recipient veins did not have any impact on the speech outcome after tongue reconstruction.…”

Section: Discussionmentioning

confidence: 98%

“…Many microsurgeons recommend double venous anastomosis if possible because it is considered to reduce flap failure, venous thrombosis, and the need for revision. 17,18 This debate is in progress in the field of head and neck reconstruction as well. Lee et al claimed that two vein anastomoses achieved better outcomes with the anterolateral thigh flap, which is one of the workhorse flaps for head and neck reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Jeong

et al. 2020

J Reconstr Microsurg

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Background Reconstruction in tongue cancer to restore the shape and function of the tongue without airway obstruction in the narrow oral cavity is challenging for reconstructive surgeons. Herein, the authors retrospectively analyzed flaps to reveal the factors that affect the functional outcome of tongue reconstruction. Methods Herein, we retrospectively reviewed 30 patients (men, 16; women, 14; mean age, 50.3 years) who underwent the hemi-tongue reconstruction followed by speech therapy between 2009 and 2017. Data about postoperative chemotherapy and radiotherapy were collected. The dimensions (width and length) of the flaps were measured. Speech outcomes were assessed under the conditions of varying distances of the tongue tip from lower incisors when it was protruded, retracted, and elevated. Lateralization was evaluated based on the count of teeth reached by the tip of the tongue from the midline. Results Preoperative chemotherapy and radiotherapy significantly influenced tongue retraction, tongue articulation, and intelligibility (p = 0.006, 0.002, 0.048, respectively). Postoperative chemotherapy did not statistically significantly influence any outcome measure. Contralateralization of the tongue was significantly decreased in the postoperative radiotherapy group (p = 0.029). The length of the flap showed highly negative correlation with articulation and intelligibility (p = 0.009, p< 0.001, respectively). The width of the flap was not correlated with the outcomes. Conclusion We proved that unlike chemotherapy, postoperative radiotherapy influences the functional outcome of tongue reconstruction. The dimensions, particularly the length of the flap, were also important for restoring the reconstructed tongue function.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Jeong

et al. 2020

J Reconstr Microsurg

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“…20 For more than 20 years, it has been debated whether to use one or two venous anastomoses. 13,21 The meta-analysis of Riot et al and Ahmadi et al, examining more than 3,000 free tissue transfers, concluded that two venous anastomoses may significantly reduce occurrence of microsurgical venous thrombosis, need for surgical revision, and overall flap Abbreviations: ALT, anterolateral thigh; SD, standard deviation.…”

Section: Discussionmentioning

confidence: 99%

“…There are flaps with a single venous system (venae comitantes), such as the ALT, groin, and gracilis muscle flaps, and then there exist flaps with dual venous systems (venae comitantes and superficial veins), such as the deep inferior epigastric perforator or the radial forearm flap, for instance. 21 Khashaba and McGregor demonstrated that in cases of a dual venous system, both systems are equally able to drain the flap, which explains why only one anastomosis is sufficient in the majority of cases. 29 Less information is available regarding hemodynamic flow patterns of single venous systems flaps.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, the meta-analysis of Ahmadi et al did not pay attention to this particular fact, 22 while Lee et al showed that dual vein drainage results in better outcomes when using ALT flaps for head and neck reconstruction. 21 Also, Chen et al advocate dual-vein drainage when using the ALT flap, arguing that better outflow can be achieved with less risk for vascular compromise. 11 Other authors such as Han et al 20 (evaluating fibula flaps) and our group (ALT and groin flaps) found no differences in success rates comparing one versus two venous anastomoses.…”

Section: Discussionmentioning

confidence: 99%

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One versus Two Venous Anastomoses in Microvascular Upper Extremity Reconstruction

Ehrl

Heidekrueger

Heine-Geldern

et al. 2017

J reconstr Microsurg

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Background Free tissue transfers are routinely performed for reconstruction of the upper limb. Main complication in free flap surgery still stems from vascular compromise and many technical controversies exist regarding the technical details of how to perform the microvascular anastomosis. This study evaluates outcomes regarding the execution of one versus two venous anastomoses for upper limb reconstruction. Methods In this study, 79 patients underwent 86 free anterolateral thigh (ALT) or groin flaps for upper limb reconstruction after trauma, infection, or malignancies. The data were retrospectively screened for patients' demographics, perioperative details, flap survival, and surgical complications. The cases were divided into two groups regarding the number of performed venous anastomoses: one versus two veins. Results No significant differences existed between the two groups regarding preoperative comorbidities (ALT: 16 one, 21 two veins; groin: 16 one, 33 two veins). Overall, there was no significant difference regarding the rate of major (1 vein: 18.8% vs. 2 veins: 20.4%; p > 0.05) and minor (1 vein: 3.1% vs. 2 veins: 3.7%; p > 0.05) surgical complications during the 3-month follow-up period. Major complications included total flap losses of 9.4% (1 vein) versus 7.4% (2 veins) (p > 0.05). Conclusion This study analyzed a series of microsurgical reconstructions with a focus on the impact of the number of performed venous anastomoses. The findings suggest that successful free tissue transfer for upper limb reconstruction can be achieved independent of the number of venous anastomoses. However, to promote additional safety, a second vein should be performed whenever technically possible.

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Recipient Vessels for Genital Reconstruction

Jahromi

Shenaq

Stoehr

et al. 2021

Recipient Vessels in Reconstructive Microsurgery

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One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation

Abstract: Therapeutic, III.

Cited by 25 publications

References 20 publications

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

Analysis of Speech and Functional Outcomes in Tongue Reconstruction after Hemiglossectomy

One versus Two Venous Anastomoses in Microvascular Upper Extremity Reconstruction

Recipient Vessels for Genital Reconstruction

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