The venae comitantes clipping test for the evaluation of the venous drainage of the radial forearm free flap

Abstract

Risks of failure of the radial forearm free flap (FRFF) are mainly related to venous congestion. Two different venous drainage system have been described for the FRFF, but the choice of the best one is still controversial. The superficial systems have a larger diameter and a thicker wall veins which makes them easier to anastomose. The deep system provides most part of the venous outflow if the caliber of the venae comitantes (VCs) is adequate. We propose an intra-operative method to evaluate the FRFF venous drainage: the VCs clipping test. The test has been used in the choice of the vein to anastomose in 12 consecutive patients with oral cavity post oncological defects reconstructed with the FRFF. The cephalic vein was included in the flap; the VCs were individually clipped with small liga-clips and divided with the radial artery still patent. The flap was kept with arterial inflow and superficial venous outflow till the recipient site was ready. If there were no signs of venous stasis, the VCs were kept clipped and the cephalic vein anastomosis was made. If clinical signs of venous stasis were revealed, the largest of the VCs was anastomosed to a vein of adequate caliber in the neck. No signs of flap venous congestion were observed in the postoperative period. No flap necrosis occurred. In this small series of patients the venae comitantes clipping test showed to be an easy, reliable and reproducible method to assess intra-operatively which vein to anastomose. © 2015 Wiley Periodicals, Inc. Microsurgery 36:647-650, 2016.

The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction

“…There is still a debate as to which venous system (cephalic or comitantes veins) should be anastomosed, but we found the anastomosis of the cephalic vein only was reliable in 71.6 % of the cases (n = 78). This finding confirms the recent experience of S. Razzano et al [11]. Adequate venous out-flow must be assured to guarantee the survival of free flaps.…”

An important superficial vein of the radial aspect of the forearm: An anatomical study

“…Razzano et al ., 2016[ 12 ] in 2013 have described the ‘vena comitantes clipping test’. Here, the authors dissect the vena comitantes and the cephalic vein at the level of cubital fossa and then clips the vena comitantes to test the venous drainage sufficiency in the skin paddle of the radial forearm flap.…”

Vascular anastomosis between the superficial and deep venous system in radial forearm free flap to prevent venous congestion

“…Venous drainage of RFFF is double, including the superficial venous system and the deep radial system with vena comitans. Razzano et al (Razzano et al, 2016) described a surgical technique to avoid venous complications: branching the superficial system alone at the level of the cephalic vein or branching the deep system alone using one or two venae comitantes. If only one system is anastomosed (Selber et al, 2011), Selber et al reported that 5.7% of postoperative congestion needs revision surgery for flap salvage in each configuration.…”