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. 2021 Apr 26;5(2):2473974X211006927.
doi: 10.1177/2473974X211006927. eCollection 2021 Apr-Jun.

Outcomes of Single Anastomoses for Superficial and Deep-System Venous Drainage of Radial Forearm Free Flaps

Mauricio Alejandro Moreno  1 , Luke T Small  2 , James Reed Gardner  1 , Alexandrea H Kim  3 , Emre Vural  1 , Jumin Sunde  1
Affiliations

Outcomes of Single Anastomoses for Superficial and Deep-System Venous Drainage of Radial Forearm Free Flaps

Mauricio Alejandro Moreno et al. OTO Open. .

Abstract

Objective: Venous insufficiency occurs in radial forearm free flaps (RFFFs) when either the deep venous system (DVS) or superficial venous system (SVS) is used as the venous outlet. We report our experience using the antecubital perforating vein (APV) in a single-vessel anastomosis to the median-cubital or cephalic vein to drain both systems.

Study design: Retrospective review.

Setting: Single, academic, tertiary care center.

Methods: Data were collected from 72 patients who underwent RFFF from October 2009 to January 2017. In all cases, DVS and SVS were dissected, and an APV single-vessel anastomosis was attempted.

Results: Anatomical variations precluded single-vessel anastomosis in 11 (15.3%) cases. In 61 (84.7%) cases, single-vessel anastomosis produced unobstructed drainage for DVS and SVS without intrinsic venous insufficiency. Venous thrombosis and total loss occurred in 2 (3.3%) and 1 (1.6%) patients, respectively. Proximal dissection of the cephalic vein addressed a vessel-depleted neck in 3 cases.

Conclusion: The antecubital perforating vein is present and functional in most patients, allowing for single anastomosis techniques for RFFF. Antecubital perforators capture DVS and SVS outflow through a single, extended venous pedicle, eliminating the risk of venous insufficiency and need for vein grafts.

Keywords: free tissue transfer; head and neck reconstruction; radial forearm free flap; single-vessel anastomosis; venous drainage.

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Figures

Figure 1.
Figure 1.
Anatomical representation of paired venae comitantes (VCs) with radial artery (RA). VC drain to the cephalic vein (C) via the anterior perforating vein (APV) and median cubital vein (MCV). Basilic vein (B) noted medially.
Figure 2.
Figure 2.
Radial forearm free flap with pedicle containing the deep venous system (DVS) and superficial venous system (SVS).
Figure 3.
Figure 3.
Subfascial dissection of venous pedicle with cephalic vein indicated by **, antecubital vein indicated by arrow, and the venae comitantes indicated by *.
Figure 4.
Figure 4.
Radial forearm free flap with vascular pedicle prepared for ligation. The cephalic vein and radial artery are indicated by * and ** respectively.
See this image and copyright information in PMC

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