PMC5811302_01
Intraoperative view of case 1. The defect was reconstructed with a free jejunal flap with 2 anastomosed veins: 1 to the left internal jugular vein in an end-to-side manner (white arrow) and the other to the left external jugular vein in an end-to-end manner (black arrow).
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F1
Immediate reconstruction was performed with a free jejunal flap with 2 anastomosed veins: 1 to the left internal jugular vein in an end-to-side manner and the other to the left external jugular vein in an end-to-end manner (Fig. 1).
Postoperative CT image of case 1. Although the recipient left internal jugular vein was completely thrombosed (red arrow), the left external jugular vein was patent as the recipient vein (yellow arrow). Green arrow indicates patent contralateral internal jugular vein.
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F2
On postoperative day 7, computed tomography (CT) images revealed complete thrombosis of the left internal jugular vein, including the anastomosed site, although the monitoring flap seemed viable, apparently because the external jugular vein had been patent as the drainage vein (Fig. 2).
Intraoperative view of case 1 at the reopening of the incision for wound drainage. The complete thrombosis of the left internal jugular vein was confirmed macroscopically (black arrow).
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F3
The complete thrombosis of the left internal jugular vein was confirmed (Fig. 3), but the free jejunal flap survived completely.
PMC5811302_02
Postoperative CT image of case 2. The left internal jugular vein was completely thrombosed (red arrow), but venous drainage of the flap was maintained through the external jugular vein as the recipient vein (yellow arrow). Blue arrow indicates the anastomotic coupler. The contralateral internal jugular vein was patent (green arrow).
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F4
On postoperative day 18, CT images revealed complete thrombosis of the left internal jugular vein (Fig. 4).