Objectives:
Free flap microsurgical reconstruction of defects in head and neck region has become a routine procedure with worldwide acceptance. It is still a controversial issue whether performing one venous (1V) or two venous (2V) anastomoses. The aims of this study were to clarify the controversy whether 1V or 2V anastomoses yield better outcome and the result between different venous drainage system in head and neck reconstruction.

Materials and Methods:
The retrospective study enrolled the cases who received free flap reconstruction of head and neck region in Hualien Tzu Chi General Hospital from November, 2007 to October, 2019. Demographic characteristics and perioperative variables were prospectively collected. The primary outcomes were flap survival rate, take back rate and successful salvage rate between 1V and 2V group. Besides, all cases are divided into four groups according to different venous drainage systems (external jugular vein (EJV) system only, internal jugular vein (IJV) system only, EJV + IJV and other) and analyzed the parameters as outcomes which mentioned above.

Results:
During the study period, total of 173 cases were included in the study with 31 cases in 1V group and 142 cases in 2V group. No significant differences were noted in preoperative clinical parameters. Moreover, there were also no significant differences in ratio of coronary artery disease, diabetes mellitus, hypertension, pre-op radiotherapy and pre-op chemotherapy. The flap survival rate was 93.5% in 1V group and 93.7% in 2V group respectively. There were no significant differences in take back rate (6.5% vs. 6.3%, p=1.000). The successful salvage rate was 33.3% vs. 25%. About complications of flap, no statistically significant differences were found in the incidence of partial necrosis, dehiscence and monitor flap necrosis. Besides, flap survival rate was 90.9% in EJV only, 94.7% in IJV only, 94% in EJV + IJV and 93.3% in other groups and the p value was 0.946. Furthermore, no statistically significant differences in terms of ratio of pedicle problem, take back rate and complication rates.

Conclusions:
In our single-center study of 173 cases who underwent head and neck microsurgical reconstruction, there were no differences noted in flap survival rate and take back rate between one venous anastomosis or two venous anastomoses. Besides, there were also no outcome differences between different venous drainage systems.

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