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. 2018 May;26(2):91-98.
doi: 10.1177/2292550317740693. Epub 2017 Nov 21.

One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

Jennifer L K Matthews  1 , Noor Alolabi  2 , Forough Farrokhyar  2   3 , Sophocles H Voineskos  2
Affiliations

One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis

Jennifer L K Matthews et al. Plast Surg (Oakv). 2018 May.

Abstract
in English, French

Background: The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems.

Methods: A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs).

Results: Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27).

Conclusions: There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.

Historique: La nécessité d’une deuxième anastomose veineuse lors d’une opération par lambeau libre est matière à controverse. La présente analyse systématique visait à déterminer si l’échec du lambeau veineux et le taux de réopération étaient plus faibles après deux anastomoses veineuses. L’objectif secondaire consistait à déterminer si l’échec du lambeau veineux et le taux de réopération étaient plus faibles lorsque les deux veines provenaient de deux systèmes de drainage différents.

Méthodologie: Les chercheurs ont repéré les études pertinentes au moyen d’une recherche approfondie des publications. De manière indépendante, ils ont extrait les données sur le taux d’échec des lambeaux et des réopérations après une congestion veineuse. Ils ont procédé à une méta-analyse et ont regroupé les rapports de cote (RC) au moyen d’un modèle à effet aléatoire et d’intervalles de confiance (IC) à 95 %.

Résultats: Sur les 18 190 études extraites, les chercheurs en ont inclus 15 dans l’analyse. Leur échantillon moyen était de 287 patients (minimum 102, maximum 564). Ils n’ont pas constaté de différence statistiquement significative des échecs des lambeaux lorsqu’ils comparaient une ou deux anastomoses veineuses (RC 1,35; IC à 95 % 0,46 à 3,93). Ils ont constaté une diminution significative du taux de réopérations attribuables à une congestion veineuse (RC 3,03; IC à 95 % 1,64 à 5,58). Les résultats favorisent le recours à deux veines de deux systèmes veineux différents plutôt que d’un même système (RC 0,16; IC à 95 % 0,02 à 1,27).

Conclusions: Selon des preuves de faible qualité, le recours à deux anastomoses veineuses réduit le taux de réopérations attribuables à une congestion veineuse. Les données publiées sont insuffisantes pour comparer de manière significative les résultats des lambeaux de deux anastomoses provenant de systèmes différents à ceux des lambeaux provenant d’un même système.

Keywords: flap failure; microsurgery; venous anastomoses.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection.
Figure 2.
Figure 2.
Forest plot of free flap venous failures—all studies.
Figure 3.
Figure 3.
Forest plot of reoperations secondary to venous congestion—all studies.
Figure 4.
Figure 4.
Forest plot of free flap venous failures—subgroup analysis of studies explicitly comparing the effect of 1 versus 2 venous anastamoses.
Figure 5.
Figure 5.
Forest plot of reoperations secondary to venous congestion—subgroup analysis of studies explicitly comparing the effect of 1 versus 2 venous anastamoses.
Figure 6.
Figure 6.
Forest plot—reoperations secondary to venous congestion: 2 venous anastomoses from different systems (2V2 S) versus 2 anastomoses from same system (2V1 S).
None
See this image and copyright information in PMC

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