Venous drainage of the radial forearm flap: comparison of the deep and superficial systems

Abstract

Background: The purpose of this study is to compare complications between the superficial and deep venous drainage systems of the free radial forearm flap to aid in selection of venous drainage in a commonly used flap.

Methods: A retrospective cohort of 370 radial forearm free flaps performed between 1998 and 2008 were reviewed. Multiple population and outcome variables were compared among outcome groups. A technique was implemented to explore the venae comitantes at the wrist crease to determine their adequacy before a full-scale flap elevation.

Results: There were a total of 21 venous complications requiring re-exploration (5.7%) and 5 flap failures (1.4%). The incidence of inadequate venous outflow was 2.2% when the venae comitantes were used alone and adding a cephalic vein for drainage salvaged half of the flaps. The incidence of inadequate venous outflow was 3.8% when the cephalic vein was used alone and adding a venae comitans for drainage salvaged all the flaps.

Conclusions: The problem of inadequate outflow in the radial forearm flap is more commonly seen when selecting the cephalic vein, or using both the deep and superficial systems together. When of adequate caliber, the venae comitantes should be selected as the sole venous outflow for this flap.