Outcomes of Single Anastomoses for Superficial and Deep-System Venous Drainage of Radial Forearm Free Flaps. Issue 2 (April 2021)

• Record Type: Journal Article
• Authors: Moreno, Mauricio Alejandro; Small, Luke T.; Gardner, James Reed; Kim, Alexandrea H.; Vural, Emre; Sunde, Jumin
• Is Part Of: OTO open. Volume 5:Issue 2(2021)
• Publication Date: 2021-04
• Subjects: radial forearm free flap -- free tissue transfer -- head and neck reconstruction -- single-vessel anastomosis -- venous drainage; Otolaryngology -- Periodicals; Otolaryngology; Electronic journals; Periodicals; 617.51
• DOI: 10.1177/2473974X211006927
• Languages: English
• ISSNs: 2473-974X

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.