SURGICAL PATTERNS OF VENOUS DRAINAGE OF THE FREE FOREARM FLAP IN HEADAND NECK RECONSTRUCTION

A retrospective review of 40 consecutive free forearm flaps used in he ad and neck reconstruction in our Head and Neck Service identified fiv e different patterns of venous drainage. In type 1, the cephalic vein and two venae comitantes join into a larger median cubital vein, which itself splits into two sizable branches (n=8, two anastomoses). In ty pe 2, a median cubital vein drains both the cephalic vein and the two venae comitantes (n=17, single anastomosis). In type 3, the cephalic v ein and the confluence of two venae comitantes are drained separately (n=7, two anastomoses). In type 4, the cephalic vein and each of two v enae comitantes are anastomosed separately (n=2, three separate anasto moses). In type 5, the cephalic vein and the larger of the two venae c omitantes are drained separately (n=6, two anastomoses). Understanding these possible venous drainage patterns substantially expedites the r aising of the free forearm flap. The selection of patterns 1 and 2, wh en possible, with the large-caliber veins ensures the safety of the fl ap. Long vascular pedicles permit anastomoses to contralateral neck re cipient vessels, obviating vein grafts, and permit safe full head and neck mobility.