Interposition vein grafts in microvascular head and neck reconstruction

Objectives/Hypothesis: To understand when interposition vein grafting may be needed in head and neck reconstruction and become familiar with the factors associated with use of interposition grafts and their effect on free flap survival. Study Design: Descriptive case-series design in a tertiary referral center. Methods: Charts were reviewed in patients undergoing interposition vein grafts for microvascular reconstruction of head and neck defects between August 1998 and February 2009. Results: In a 10-year period, interposition vein grafts were used in 20 free tissue transfers, representing 1.7% of all microvascular reconstruction cases (n = 1,143). Seventy percent of vein grafts were used in cases of secondary reconstruction or prior radiotherapy. Free flap survival in the interposition vein graft group was 95%, compared with 96% overall flap survival. Conclusions: Interposition vein grafts are used most often in cases involving a threatened flap, prior free flap, flap failure or radiation, and tumor recurrence. The use of interposition vein grafting in microvascular reconstruction is not associated with decreased flap survival.