J Reconstr Microsurg 2003; 19(6): 371-376
DOI: 10.1055/s-2003-42631
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Fail-Safe Drainage Procedure in Free Radial Forearm Flap Transfer

Akihiro Ichinose1 , Shinya Tahara1 , Satoshi Yokoo2 , Makoto Omori1 , Suguru Miyamura1 , Yori Tsuji1 , Kenich Nibu3 , Miki Saito3
  • 1Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
  • 2Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
  • 3Department of Otorhinolaryngology, Kobe University Graduate School of Medicine, Kobe, Japan
Further Information

Publication History

Publication Date:
29 September 2003 (online)

ABSTRACT

The reliability of the free radial forearm flap is widely accepted; however, postoperative venous thrombosis still occurs occasionally. Thus, establishment of a fail-safe drainage system has been a challenging frontier. A total of 405 consecutive free radial forearm flap transfers, carried out in the authors' department between 1987 to 2002, were reviewed retrospectively. The most reliable drainage method comprised the dual flap drainage veins of the superficial venous system (the cutaneous vein) and the deep system (the radial vena comitans), including their connecting cubital perforating vein, and the two neck recipient veins of the internal jugular and the external jugular venous systems. None of the flaps transferred by this method incurred venous failure, regardless of the surgeons conducting the operation. This study on the venous network in drainage systems of the free radial forearm flap demonstrated that the described method functions in a self-sustaining manner, and contributes to protection against venous catastrophe.

REFERENCES

  • 1 Evans G R, Schusterman M A, Kroll S S. The radial forearm free flap for head and neck reconstruction: a review.  Am J Surg . 1994;  168 446-450
  • 2 Soutar D S, McGregor I A. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases.  Plast Reconstr Surg . 1986;  78 1-8
  • 3 Moscoso J F, Urken M L. Radial forearm flaps.  Otolaryngol Clin North Am . 1994;  27 1119-1140
  • 4 Boyd J B, Mulholland R S, Davidson J. The free flap and plate in oromandibular reconstruction: long-term review and indications.  Plast Reconstr Surg . 1995;  956 1018-1028
  • 5 Tahara S, Susuki T. Eye socket reconstruction with free radial forearm flap.  Ann Plast Surg . 1989;  23 112-116
  • 6 Coleman III J J, Wooden W A. Mandibular reconstruction with composite microvascular tissue transfer.  Am J Surg . 1990;  160 390-395
  • 7 Schwartz M S, Cohen J I, Meltzer T. Use of the radial forearm microvascular free-flap graft for cranial base reconstruction.  J Neurosurg . 1999;  651-655
  • 8 Pribaz J J, Weiss D D, Mulliken J B, Eriksson E. Prelaminated free flap reconstruction of complex central facial defects.  Plast Reconstr Surg . 1999;  104 357-367
  • 9 Anthony J P, Singer M I, Mathes S J. Pharyngoesophageal reconstruction using the tubed free radial forearm flap.  Clin Plast Surg . 1994;  21 137-47
  • 10 Benacquista T, Strauch B. Avoiding the unfavorable outcome in microsurgery. In: Goldwin RM, Cohen MN, eds. Plastic Surgery, 3rd ed Philadelphia: Lippincott Williams & Wilkins 1999: 205-256
  • 11 Khouri R K, Cooley B C, Kunselman A R. A prospective study of microvascular free-flap surgery and outcome.  Plast Reconstr Surg . 1998;  102 711-721
  • 12 Kroll S S, Schusterman M A, Reece G P. Timing of pedicle thrombosis and flap loss after free-tissue transfer.  Plast Reconstr Surg . 1996;  98 1230-1233
  • 13 Percival N J, Sykes P J, Earley M J. Free flap surgery: the Welsh Regional Unit experience.  Br J Plast Surg . 1989;  42 435-440
  • 14 Yang G F, Chen P J, Gao Y Z. Forearm free skin flap transplantation: a report of 56 cases.  Br J Plast Surg . 1997;  50 162-165
  • 15 Timmons M J. The vascular basis of the radial forearm flap.  Plast Reconstr Surg . 1986;  77 80-92
  • 16 Thoma A, Archibald S, Jackson S, Young J E. Surgical patterns of venous drainage of the free forearm flap in head and neck reconstruction.  Plast Reconstr Surg . 1994;  93 54-59
  • 17 Tahara S, Takagi T, Kinishi M. Role of the perforating vein in vascular pedicle of free forearm flap.  Microsurgery . 1995;  16 743-745
  • 18 Futran N D, Stack Jr C B. Single versus dual venous drainage of the radial forearm free flap.  Am J Otolaryngol . 1996;  17 112-117
  • 19 Demirkan F, Wei F C, Lutz B S. Reliability of the venae comitantes in venous drainage of the free radial forearm flap.  Plast Reconstr Surg . 1998;  102 1544-1548
  • 20 Ichinose A, Tahara S, Terashi H. Importance of the deep vein in radial forearm flap transfer-A haemodynamic study.  Scand J Plast Reconstr Surg . 2003;  37 145-149
  • 21 Ichinose A, Tahara S, Terashi H. Short-term postoperative flow changes after radial free forearm flap transfer: possible cause of vascular occlusion.  Ann Plast Surg . 2003;  50 160-164
  • 22 Machens H G, Mailaender P, Reimer R. Postoperative blood flow monitoring after free-tissue transfer by means of the hydrogen clearance technique.  Plast Reconstr Surg . 1997;  99 493-505
  • 23 Khouri R K, Shaw W W. Monitoring of free flaps with surface-temperature recordings: is it reliable?.  Plast Reconstr Surg . 1992;  89 495-502
  • 24 Shah D K, Zhang W X, Forman D L. Combination therapy for salvaging a failing, experimental skin flap.  J Reconstr Microsurg . 1996;  12 365-369
  • 25 Yii N W, Evans G R, Miller M J. Thrombolytic therapy: what is its role in free flap salvage?.  Ann Plast Surg . 2001;  46 601-604
  • 26 Brown D H, Mulholland S, Yoo J H. Internal jugular vein thrombosis following modified neck dissection: implications for head and neck flap reconstruction.  Head Neck . 1998;  20 169-174
  • 27 Fisher C B, Mattox D E, Zinreich J S. Patency of the internal jugular vein after functional neck dissection.  Laryngoscope . 1988;  98 923-926
  • 28 Leontsinis T G, Currie A R, Mannell A. Internal jugular vein thrombosis following functional neck dissection.  Laryngoscope . 1995;  105 169-173
  • 29 Kubo T, Haramoto U, Yano K. Internal jugular vein occlusion in head and neck microsurgical reconstruction.  Ann Plast Surg . 2002;  49 490-494
  • 30 Swartz W M, Banis J C. Head and Neck Microsurgery.  Baltimore: Williams and Wilkins, 1992: 36-46
  • 31 Vaughan E D. The radial forearm free flap in orofacial reconstruction. Personal experience in 120 consecutive cases.  J Craniomaxillofac Surg . 1990;  18 2-7