Early detection and successful management of postoperative external jugular vein thrombosis using color doppler ultrasonography after free jejunal transfer

Postoperative venous thrombosis is a known complication of free flap reconstruction, yet thrombosis of the external jugular vein (EJV) remains underreported. We present two cases of EJV thrombosis following free jejunal transfer, both detected early using color Doppler ultrasonography (CDU) and successfully managed with anticoagulation therapy. In Case 1, EJV was used after failure of a prior jejunal flap anastomosed to the internal jugular vein (IJV). CDU on postoperative day (POD) 0 showed thrombus characterized by flow voids and incomplete vein collapse, prompting heparin administration. In Case 2, CDU on POD 1 similarly revealed early thrombus in the EJV. In both cases, daily CDU monitoring demonstrated progressive improvement, allowing flap salvage without surgical reintervention. These cases highlight the utility of CDU for early postoperative surveillance and timely clinical decision-making. CDU facilitated early detection of venous thrombosis, often preceding clinical signs of vascular compromise. Although less favored than the IJV, the EJV can be safely used for microvascular anastomosis with careful monitoring. Our experience supports the use of CDU to guide anticoagulation therapy and optimize outcomes in free flap reconstruction involving the EJV.