Abstract
Background This study was conducted to evaluate the impact of choosing a particular recipient
venous system on venous patency and flap survival in 652 head and neck free flap reconstructions.
Methods A retrospective review was performed. Patient factors investigated included: age,
sex, type of flap, tumor location, history of radiation, presence of previous neck
dissection, tumor stage, and any underlying disease. Data related with recipient vein
including the number of anastomosis, the repair technique, the type of recipient vein,
and the configuration of selected venous system were examined. The impact of patient
factors and parameters related with recipient vein on the venous patency and flap
survival were analyzed using bivariate and multivariate analyses.
Results Of 652 free flaps, 36 flaps (5.5%) were re-explored due to venous congestion and
28 flaps (77.8%) were salvaged. The overall survival rate of total free flaps was
98.8%. The type of recipient venous system was found to be an insignificant factor
with respect to venous congestion and flap survival in multivariate analysis. A history
of radiation treatments was the only factor associated with a higher risk of venous
compromise (odds ratio [OR] = 13.138, p < 0.001) and a lower rate of flap survival (OR = 20.182, p = 0.002).
Conclusion The selection of recipient venous systems has no impact on venous patency and flap
survival. History of radiation treatment was the only factor associated with venous
congestion and flap failure. Since no single method can ensure a successful reconstructive
result, selecting the optimal recipient vein should be based on individual patient
factors and the surgeon's experience.
Keywords
head and neck reconstruction - recipient vein - flap viability
