Stranix JT, et al. - Authors here determined the effect of an additional venous anastomosis on flap outcomes in lower extremity trauma reconstruction. Compared to single-vein flaps, lower extremity trauma free flaps with two venous anastomoses showed a fourfold decrease in complication rates. Furthermore, venous size mismatch >1 mm proved to be an independent predictor of total flap failure, suggesting the importance of both two-vein outflow and matched vessel diameter.