Single versus dual venous drainage of the radial forearm free flap

Abstract

Purpose: To compare single versus dual venous drainage of radial forearm free flaps (RFFF) and its impact on flap survival. Design: A retrospective case series of 43 consecutive patients undergoing radial forearm free flap reconstruction for head and neck cancer defects, combined with a meta-analysis of 218 reported cases. Setting: Two academic, tertiary referral medical centers. Intervention: All 43 RFFF's were harvested and inset in a similar fashion. In 16 patients (group 1), two venous anastomoses were performed. In 27 patients (group 2) one anastomosis was created. The arterial anastomosis was similar in both groups. Outcome Measures: Clinically noted viability of the radial forearm free flap over the first 6 postoperative weeks. Results: All 43 RFFFs maintained complete viability. No flap loss, complete or partial, was identified. Two patients in group 1 and one patient in group 2 developed postoperative pharyngocutaneous fistulae, but complete healing occurred with local wound care. One patient in group 2 developed a postoperative neck hematoma, which was evacuated with no insult to the free flap. Single venous anastomosis shortened operative time by 21 to 36 minutes. Conclusion: Though two venous anastomoses may provide a more fail-safe mechanism for adequate venous drainage, a single venous anastomosis employing a subcutaneous vein provides adequate drainage with reduced operative time and no additional morbidity. Meta-analysis statistically confirmed the equivalency of single and dual venous amastimoses with respect to flap survival.