Double venous anastomosis for the radial artery forearm flap. Improving success and minimising morbidity

• Published in: Journal of cranio-maxillo-facial surgery 2009-07, Vol.37 (5), p.253-257
• Main Authors: Alan Turner, Mark Jürgen, MRCS, Smith, William P., FRCS
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Surgical - methods; Biological and medical sciences; Blood and lymphatic vessels; Carcinoma, Squamous Cell - rehabilitation; Carcinoma, Squamous Cell - surgery; Cardiology. Vascular system; Dentistry; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Forearm - blood supply; Graft Survival; Head and Neck Neoplasms - rehabilitation; Head and Neck Neoplasms - surgery; Humans; Male; Medical sciences; Middle Aged; Otorhinolaryngology. Stomatology; Radial Artery - transplantation; radial forearm free flap; Reoperation - statistics & numerical data; Retrospective Studies; Skin - blood supply; Skin Transplantation - methods; Surgery; Surgical Flaps - blood supply; Tissue and Organ Harvesting - methods; Treatment Outcome; venous thrombosis
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2008.09.002

Summary Introduction We present a retrospective analysis of 106 radial forearm free flaps (RFFFs) using double venous anastomoses as performed at Northampton General Hospital over an 11-year period. The aim was to assess the failure rate and salvage rate for venous thrombosis of these flaps. Methods RFFFs were raised with the cephalic vein where possible. The cephalic vein and 1 venae commitantes or 2 venae commitantes (VC) were anastomosed using microscope assistance. The veins were anastomosed end to side on to the internal jugular vein (IJV). Data was collected from patient notes using a proforma and entered onto an Access™ database. Results Of the 106 RFFFs there was 1 (0.94%) failure at day 9, a presumed arterial failure. None of the 106 RFFFs were returned to theatre for salvage for venous thrombosis. Conclusion Our results compare favourably with similar published data. Comparable studies gave a mean failure rate of 4% (range of 0–10%) and 7% (range 3–12.5%). We believe our results are due to: 1 – Double venous anastomosis, 2 – end to side anastomosis to the IJV using deep and superficial systems, 3 – initial anastomosis of the cephalic vein low in the neck to shorten ischaemic time. 4 – overnight sedation and ventilation of the patient on the intensive care unit.