Comparison Of Thrombosis And Failure Rate Of Free Flaps With Two Types Of Recipient Vein System Anastomosis In Free Flaps For The Reconstruction Of Head And Neck Defects: A Meta-analysis

Objective: The purpose of this study was to investigate the differences in postoperative thrombosis and failure rate of flaps between internal jugular vein(IJV)system anastomosis and external jugular vein(EJV)system anastomosis in free flaps for the reconstruction of head and neck defects by meta-analysis.Methods: Two researchers independently searched PubMed,Web of Science,EMBASE,Chinese BioMedical Literature Database(CBM)and other databases until December 2019 for the studies that reported data for anastomosis for the two different venous systems in the microvascular free-flap reconstruction of head and neck defects.Statistical data were analyzed statistically by STATA 13.0.Results: Nine studies with a total of 2058 cases with venous anastomosis were included in this meta-analysis.IJV system anastomosis showed a significantly lower venous thrombosis than did the EJV system(Relative Risk = 0.53;95%CI: 0.36,0.78).The results were significantly different(P = 0.001).Eight studies were included in the analysis of flap failure rates,and the IJV system anastomosis had a lower failure rate than the EJV system(RR = 0.58;95%CI: 0.35,0.98;P = 0.041).Conclusions: The incidence of thrombosis and flap failure after venous anastomosis in the IJV system was lower than that in the EJV system in free flaps for the reconstruction of head and neck defects.The IJV system can be identified as the first choice for the reconstruction in single vein anastomosis.