Importance of the Deep Vein in the Drainage of a Radial Forearm Flap: A Haemodynamic Study

New circulation in the free flap reestablished at the recipient site is the key to successful microvascular reconstructive surgery. This study is the first evaluation of long-term circulatory changes in nine free radial forearm flap transfers. Postoperatively, color Doppler studies revealed that the flow volume through the arterial pedicle increased rapidly during the first 3 days, gradually increased until day 14 (exceeding flow volume through the facial artery of the unoperated contralateral side), then decreased slightly until the sixth month. The pulsatility index, representing vascular resistance downstream, decreased successively. Ohm's law explains that this flow increase is caused by reduced vascular resistance downstream, attributed to changes in the vascularity of the transferred flap and in the recipient bed. The authors believe the circulatory changes are determinants of the clinical properties of the flap. This study addresses the importance of clarifying the events that transpire at the macroscopic circulatory level in the transferred free flap.

mentioning

confidence: 99%

Reestablished Circulation After Free Radial Forearm Flap Transfer

Ichinose

Tahara²,

Terashi³

et al. 2004

“…Several studies, however, have established the superiority and reliability of using the deep venae comitantes. [7][8][9] Given the technical challenge of performing microvascular anastomoses, several studies have explored the feasibility of using a microvascular coupler or mechanical anastomotic device as a safe and effective alternative to the traditional hand-sewn technique. [11][12][13][14][15] Most recently and perhaps most pertinent to our experience, Zhang et al were able to demonstrate the versatility of venous couplers in head and neck reconstruction with a wide variety of free flaps.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,6 Although debated in the past, the reliability of the deep system (venae comitantes) over the superficial system (cephalic, basilic vein) for drainage has been demonstrated. [7][8][9] The venae comitantes of the radial forearm, however, are often smaller in diameter than the veins of the superficial system, making the venous anastomosis to the recipient vessels in the neck more tedious, particularly in a previously operated or radiated neck. Successful free-tissue transfers are dependent on the quality of the anastomosis.…”

mentioning

confidence: 99%

Reliability of Venous Couplers for Microanastomosis of the Venae Comitantes in Free Radial Forearm Flaps for Head and Neck Reconstruction

Patel

Pang

Natoli

et al. 2013

The radial forearm free flap has gained popularity in head and neck reconstruction after oncologic resection because of its versatility. This popularity has only intensified with the advances in technique and instrumentation. Although debated in the past, the success of using the deep venae comitantes system for flap drainage is well documented. Although the use of couplers in a variety of flap anastomoses has been described in the literature, to our knowledge this is the first series presented on the use of couplers in small, deep system venae comitantes. We retrospectively examined our experience in 61 patients who underwent radial forearm free flaps for head and neck reconstruction. Of the 61 patients, 22 anastomoses were hand sewn, and 39 anastomoses were performed using venous couplers. No flap losses occurred in the group in whom venous couplers were used. In addition, no intraoperative thromboses, arterial or venous, were noted with coupler use. Our series demonstrates that the venous coupler is a safe and effective alternative to the hand-sewn anastomosis of the radial forearm free flap venous comitantes in head and neck reconstruction.

“…Flap evaluation All the radial forearm flaps were elevated as previously described. 20,21 In short, the skin paddle was located on the distal side of the forearm. For vascular pedicles, the radial artery, the cutaneous, and the deep veins (radial venae comitantes) were dissected proximally up to the antecubital fossa.…”

Section: Patientsmentioning

confidence: 99%

“…The perforating vein can increase blood flow into the cutaneous vein by supplying blood from the deep vein, as found in our experience and as so reported previously. 20,21 When both the cutaneous and the deep veins are employed for drainage veins, our previous studies have shown that the flow through the former is occasionally low immediately after flap transfer 21,22 ; the perforating vein can then protect against thrombosis.…”

Section: Role Of the Cubital Perforating Veinmentioning

confidence: 99%

Fail-Safe Drainage Procedure in Free Radial Forearm Flap Transfer

Ichinose

Tahara²,

Yokoo³

et al. 2003

The reliability of the free radial forearm flap is widely accepted; however, postoperative venous thrombosis still occurs occasionally. Thus, establishment of a fail-safe drainage system has been a challenging frontier. A total of 405 consecutive free radial forearm flap transfers, carried out in the authors' department between 1987 to 2002, were reviewed retrospectively. The most reliable drainage method comprised the dual flap drainage veins of the superficial venous system (the cutaneous vein) and the deep system (the radial vena comitans), including their connecting cubital perforating vein, and the two neck recipient veins of the internal jugular and the external jugular venous systems. None of the flaps transferred by this method incurred venous failure, regardless of the surgeons conducting the operation. This study on the venous network in drainage systems of the free radial forearm flap demonstrated that the described method functions in a self-sustaining manner, and contributes to protection against venous catastrophe.