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

Abstract

Failure of the radial forearm free flap (RFFF) in head and neck reconstruction is commonly related to 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. Both systems can be anastomosed,