External jugular vein (EJV) and internal jugular vein (IJV) are major options for recipient veins in microvascular free flap reconstruction of the head and neck. Recently, it has been reported that EJV has higher thrombosis rates and more flap complications than IJV.
We recognized venous valve thrombosis of EJV in 3 cases, when we anastomosed EJV and donor vein at a distal part of the valve. To resolve the problem, we performed a segmental resection of EJV involving venous valves and also anastomosed end to end All anastomoses were successfully done and flaps were taken.
There are several reports about venous valve thrombosis in EJV and the risk of thrombosis is higher due to neck dissection and other surgical interventions. To use EJV safely, we suggest careful observation of EJV and the valves that are mostly found at the lower neck. When venous valve thromboses are found, we recommend surgical procedures as a resolution of venous valve thromboses, as mentioned above.