Introduction: Single or double venous anastomosis in free flap in general and ALT, in particular, is still a matter of debate between micro vascular surgeons. In this study, we will present our experience in single vein anastomosis versus double venous anastomosis in ALT perforator flap used in leg and foot reconstruction as regarding flap outcome, complications, operation time and the need for re-exploration. Patient and Methods: We retrospectively evaluate 60 patients with post traumatic foot and leg defects in the period between January 2014 and January 2018 where free ALT flap was done. The patients were divided into two groups, Group 1 where single vein anastomosis was done and Group 2 where double venous anastomosis was done; we utilize the deep venous system for the anastomosis in all cases. Results: Complete flap survival noticed in 56 cases (93.3%), defect size ranged from 70 to 200 cm (mean 126.35 ± 33.78). There was no difference between the 2 groups as regarding Flap survival, hospital stay, flap complications, donner site morbidity and vascular insufficiency. There is statistically significant difference between both groups as regarding Ischemia time, Operation time, and overall re-exploration rate. Conclusions: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is as safe and feasible as the two veins anastomoses.
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