One versus Two Venous Anastomoses in Microvascular Upper Extremity Reconstruction

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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.


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.


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).


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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