The Cadaveric Study of the Radial Forearm Flap Venous Drainage

Lee, Sangip

The radial forearm flap largely consists of 2 venous drainage systems- superficial and deep venous drainage. With the development of microvascular anastomosis, flap survival has risen and complications decreased. A large diameter vessel with sufficient anastomosis and venous drainage undoubtedly provides a decrease in the incidence of congestive flap necrosis. Therefore some surgeons put an emphasis on the perforating cubitalis vein (profundus cubitalis) which connects the deep and superficial systems. It’s relatively large diameter and dual system allows the surgeon of any level to make a reliable anatomosis.

Dissection of 7 Korean cadavers and 14 human cadaveric forearms were investigated. 1 vein was ruptured making the study total 13 cadaveric forearms. Radial forearm flaps were designed such as those on a real live human. Dissection of the cephalic vein, radial artery and venae comitans were made in proximity to the antecubital region where the profundus cubitalis was found or was anticipated to be. The length and communication of the profundus cubitalis with the superficial (i.e. cephalic vein) and deep venous systems (i.e. venae comintantes ) were inspected.

The average length of the Profundus cubitalis was 13mm. Seven forearms had the profundus cubitalis connecting the deep and superficial drainage systems. In 6 forearms, the profundus cubitalis did not connect both venae comitantes with the cephalic vein, thus making anastomosis of solely the profundus cubitalis impossible.

Taken together, use of profundus cubutalis could make vascular anastomosis easier and provide increased venous drainage of radial free flap.

references

1. Selber JC, Sanders E, Lin H, Yu P. Venous drainage of the radial forearm flap: comparison of the deep and superficial systems. Annals of plastic surgery. 2011;66:347-50.

2. Gottlieb LJ, Tachmes L, Pielet RW. Improved venous drainage of the radial artery forearm free flap: use of the profundus cubitalis vein. Journal of reconstructive microsurgery. 1993;9:281-4; discussion 4-5.