Author(s)
Matthew J. Stewart, BS
Ishani Khatiwala, BS
Perry Hammond, BA
Farshid Taghizadeh, BS
Brian Swendseid, MD
Ryan Heffelfinger, MD
Adam Luginbuhl, MD
Larissa Sweeny, MD
Mark K. Wax, MD
Joseph M. Curry, MD
Affiliation(s)
Thomas Jefferson University Hospital;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the factors that predict the complications or failure of ETS only free flaps. Objectives: There is limited data on the microsurgical characteristics of end to side (ETS) and end to end (ETE) anastomoses in head and neck free flap reconstruction. Our objective was to analyze the operative factors that may predict the complications or failure of ETS only free flaps by using a large, representative cohort. Study Design: Retrospective observational study across two tertiary academic medical centers. Methods: Free flap failure and complications for operative metrics were compared. Results: Of 2,685 patients undergoing free flap reconstruction, 230 were identified who underwent ETS venous anastomoses. Patients who received one ETS venous anastomosis experienced a flap failure rate of 12.95% (n=25/193) versus 0.0% (n=0/37) in those with two (p=0.0022). Using the internal jugular vein (IJV) as recipient vessel was associated with a 10.1% failure rate (n=23/227) and a 34.8% complication rate (n=79/227) versus 3.8% (n=2/53) and 17.0% (n=9/53) for an alternative vein (p=0.003, p=0.033, respectively). Using couplers <=2.0mm correlated with a failure rate 2.2% higher (7.5%; n=3/40) than using couplers >2.0mm (5.3%; n=8/151; p = 0.014). Receiving a suture anastomosis instead of a coupler anastomosis was associated with an increased rate of flap failure by 11.8% (17.6%, n=15/8 vs. 5.8%, n=11/191; p=0.005). Conclusions: Patients who undergo ETS can have varied success and complication rates based on number of venous anastomoses, recipient vessel, and coupler utilization. The use of smaller couplers and suture anastomoses may be associated with increased rate of flap failure. Performing a second ETS correlated with improved outcomes. This may be due several factors (e.g., vessel depleted neck) and further work is required to define these relationships.