Single versus double venous anastomoses in head and neck reconstruction: systematic review and cumulative meta analysis

Abstract

Background: The most common flap complication that causes flap failure is mainly due to venous thrombosis. Double venous anastomoses have been advocated in reducing the risk of venous compromise and flap failure. However, this procedure still remains controversial. Objective: The author conducted a cumulative meta-analysis to determine the benefits of double venous anastomoses in head and neck reconstruction. Methods: A literature search was conducted in accordance to the PRISMA checklist. Odds ratio (OR) was used for comparison. Statistical heterogeneity evaluation was performed using I2. If heterogeneity was non-significant, the fixed-effects model was used; otherwise, the random-effects model was used. Results: 24 articles with 6517 flaps were included in this cumulative meta-analysis. In view of venous compromise, single venous anastomoses group had a significant higher incidence compared to the double venous anastomoses (OR = 1.71; 95% CI = 1.19 to 2.45; P = 0.004). In view of flap failure, the single venous anastomoses group also tended to have a higher incidence compared to double venous anastomoses (OR = 1.69; 95% CI = 1.09 to 2.62; P = 0.018). The cumulative meta-analysis effectively demonstrates a significant increase in venous compromise at the single venous anastomoses after adding trials conducted in 2014 onwards, whilst for flap failure the significant increase in single venous anastomoses was identified after adding trials in 2015 onwards. Conclusion: The cumulative meta-analysis supports the evidence that use of two venous anastomoses reduces the incidence of venous compromise and total flap failure in head and neck reconstruction.