Twin Tower-shaped Anastomosis: Two Comitant Veins Anastomosed to a Single Recipient Vein in an End-to-end Fashion

In some cases of free flap transfer, two comitant veins must be anastomosed to a single suitable recipient vein to avoid congestion due to the lack of network between the two comitant veins. In this situation, both veins are mostly anastomosed to the recipient vein in an end-to-side fashion. However, the distal end of the recipient vein sometimes has to be cut to reach the comitant veins that are short in length. In such cases, we anastomose both of the comitant veins to a single recipient vein in an end-to-end fashion with a twin tower shape. The twin tower-shaped anastomosis technique involves two comitant veins in parallel anastomosed to a single recipient vein in an end-to-end fashion, and the gap of the two comitant veins is closed directly via an interrupted suture method. With this technique, two comitant veins and the recipient vein can be successfully anastomosed in an end-to-end fashion.