Ten-year experience of free flaps in head and neck surgery. How necessary is a second venous anastomosis?

Background Successful free flap surgery in the head and neck is dependent on the successful anastomosis of both artery and vein. The success of all free flaps was analyzed to determine the necessity for performing 2 venous anastomoses. Methods We retrospectively analyzed a single surgeon's 10‐year experience (August 1993–August 2003) in free flap reconstruction for malignant tumors of the head and neck. Four hundred ninety‐two free flaps were primary reconstructions that did not require a vein graft, vein loop, or cephalic turnover procedure. Three hundred forty‐five flaps had 1 venous anastomosis, and 147 flaps had 2 venous anastomoses. Results Overall, flap success was 468 of 492 (95.1%). Successful flap reconstruction in patients undergoing 2 venous anastomoses was 145 of 147 (98.6%) compared with 323 of 345 (93.6%) in patients undergoing 1 anastomosis (p < .05). Conclusion Where possible, a second venous anastomosis should be performed in head and neck free flap reconstruction. © 2008 Wiley Periodicals, Inc. Head Neck, 2008