653 The Impact of Preoperative Screening for Venous Pathology on Lower Limb Free Flap Reconstruction

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Abstract Aim Lower limb reconstruction free flap failure rate is 8.5% and is contributed to by venous thrombosis and congestion. Mapping of free flaps and the recipient site to identify venous pathology is not standard and often pathology is only found intraoperatively leading to changes in reconstructive plans. There are no guidelines on preoperative venous assessment. We aimed to review available evidence to delineate the impact preoperative venous imaging has on flap outcomes Method A systematic review of MEDLINE, Scopus, Web of Science, Cochrane Library and Embase were searched in August 2021. The reference lists of retrieved publications were checked manually and backward searched using Web of Science and Google Scholar. Data was reviewed by two researchers independently and compared. Results Eleven articles were eligible for inclusion encompassing 99 patients and 107 flaps with lower limb pathology at either the donor or recipient vein. Venous pathology was detected preoperatively in 69 veins using USS duplex scanning or CT angiography. Interventions included using another vein, intraoperative thrombectomy, and preoperative anticoagulation. 3 out of 69 (4.34%) of these free flaps resulted in failure. 38 veins diagnosed with venous pathology intraoperatively were managed by using an alternative vein, venotomy, thrombectomy, embolectomy or heparinising the vein. 5 out of 38 flaps failed (13.15%). Conclusions Preoperative screening for venous pathology showed higher flap survival rate. A standardised approach for identifying venous issues in lower limb free flap reconstruction is needed. Future studies should focus on the prognostic validity of preoperative screening tools and management of identified venous pathology.