Revisiting radial forearm free flap for successful venous drainage

Abstract

Tissue defect reconstruction using radial forearm free flap (RFFF) is a common surgical technique whose success or failure is mainly dependent on venous drainage. RFFF has two major venous outflow systems, superficial and deep vein. Drainage methods include combining both systems or using one alone. This review aims to recapitulate the vascular anatomy and network of RFFF as well as shed light on deep vein as a reliable venous drainage system. We also discuss basic evidence for and advantages of single microanastomosis with coalesced vein to overcome technical difficulties associated with the deep vein system.

Keywords: Coalesced vein; Radial forearm free flap; Venae comitantes.

Fig. 1

Schematic structure of the fasciocutaneous flap. Please note the septocutaneous perforator and complex vascular network originating from radial artery and venae comitantes. The cephalic vein passes through the subcutaneous layer without sprouting branches

Fig. 2

Schematic vascular structure of RFFF. Two venae comitantes are anastomosed at the coalesced vein, which drains into the median cubital vein