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

SummaryIntroductionWe 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.MethodsRFFFs 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.ResultsOf 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.ConclusionOur 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.