Single versus dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction: A retrospective study

Objective The present study was to compare the success rates of single venous anastomosis with dual venous anastomoses of the free fibula osteocutaneous flap in mandibular reconstruction. Patients and Methods Retrospective review of all cases of mandibular reconstruction using free fibula osteocutaneous flaps performed by a single surgeon in our department during the period January 2005 to April 2012. All the flaps were harvested and transplanted by the standard protocols. Microvascular anastomosis of either one or two veins was performed. In addition to routine clinical evaluation, the viability of the flap was evaluated by a portable Doppler at the tenth day after surgery. Results Two hundred and one free fibula osteocutaneous flaps were performed during this time period. Single venous anastomosis was performed in 112 flaps and dual venous anastomoses were performed in 89 flaps. The overall incidence of vascular thrombosis was 3%, and the success rate of the transplantation was 98.5%. Six cases developed vascular thrombosis postoperatively. One was arterial thrombosis that occurred 12 hours after initial operation in the dual venous anastomoses group. Three venous thrombosis occurred 24 hr after the operation in the single venous anastomosis group. In dual venous anastomoses group, two venous thrombosis occurred 3–4 days after initial operation and attempt to salvage failed in both the cases. Fisher's exact test showed that there was no significant difference of the success rate between single and dual anastomoses groups (P = 0.59). Conclusions There is no difference in success rates between single venous anastomosis and dual venous anastomoses for mandibular reconstruction with free fibula osteocutaneous flap. © 2013 Wiley Periodicals, Inc. Microsurgery 33:652–655, 2013.