Comparative Analysis of Free Flaps with Single versus Dual Venous Anastomosis.

Background: Free flaps are widely used for reconstructive surgery, with venous anastomosis-single or dual-being critical to flap survival. We compared outcomes between single and dual venous anastomoses. Methods: In a cross-sectional study at Hazrat Fatemeh Hospital, Tehran, Iran, 23 patients undergoing free flap surgery were grouped by venous anastomosis type. Primary outcome was flap survival; secondary outcomes included venous thrombosis, congestion, capillary refill, and reoperation. Confounding variables (age, diabetes, smoking, ASA score) showed no significant differences. Results: Patients with flap failure averaged 38 years; successful cases averaged 34.7 years. Flap success was higher in the dual anastomosis group (90%) than the single group (69.2%), though not statistically significant (P = 0.25). No moderate or severe congestion occurred in the dual group, which also had more cases of bright-colored flaps (58.2% vs. 41.2%, P < 0.05). Capillary refill times were similar across groups. Conclusion: Dual venous anastomosis may reduce venous congestion and improve flap appearance, though its effect on overall flap success and thrombosis was not statistically significant. Larger studies are needed to validate these findings.