We reviewed the clinical results and anastomosed veins in cases of head and neck reconstruction at our institution. Fifty-four patients with malignant tumors of the head and neck that were reconstructed using free flaps were included (39 males and 15 females, with a mean age of 60.7 years) . Two veins were anastomosed in 30 of 54 patients and one vein was anastomosed in the remaining 24.
Complete survival of the flaps was achieved in 50 of the 54 patients, but partial and total necrosis occurred in 3 and 1, respectively. Partial necrosis was due to congestion of the external jugular venous system in all cases, and total necrosis was caused by obstruction of the artery. Of the 24 patients with one venous anastomosis, partial necrosis occurred in 2 of the 7 patients with external jugular venous system anastomosis.
Nearly half of anastomosis were to a single vein and cases of anastomosis to the external jugular venous system had a higher incidence of necrosis. When using the external jugular venous system, it is necessary to avoid excessive dissection and to pay attention to vessel placement.
