Improved Venous Drainage of the Radial Artery Forearm Free Flap: Use of the Profundus Cubitalis Vein

Abstract

The radial artery forearm free flap (RAFFF) is a versatile and popular flap used in various reconstructive procedures. This flap contains two venous drainage systems: a superficial (cephalic) route, and a deep (venae comitantes) route. Most surgeons use either the deep venous system alone or in combination with a superficial vessel, hence requiring two venous anastomoses. The authors describe a novel technique of providing venous drainage for the RAFFF, incorporating both deep and superficial systems, and using one venous anastomosis. From 10 consecutive operative and five cadaveric dissections, it was noted that paired venae comitantes, corresponding to the radial artery, coalesce into a single vein at the level of the brachial artery bifurcation. The profundus cubitalis vein (vena anastomotica) connects this coalesced (deep) vein to the cephalic (superficial) vein at the level of the cubital fossa. Both the deep and superficial venous systems are drained via one large anastomosis, situated proximal to the profundus cubitalis interconnection. Advantages of this technique include: 1) improved venous drainage of the RAFFF; 2) rendering the venous anastomosis technically easier, due to its larger size; and 3) more available versatility in designing the venous portion of the vascular pedicle.