ROLE OF THE PERFORATING VEIN IN VASCULAR PEDICLE OF FREE FOREARM FLAP

An innovation in the preparation of the vascular pedicle of the free r adial forearm flap is presented, While the radial artery is commonly u sed as the arterial pedicle of the flap, either the cutaneous venous s ystem or the radial comitant vein (deep venous system) is used as the venous pedicle, The perforating vein communicates between these two ve nous systems at the cubital fossa, and we confirmed its presence in al l but one of more than 180 cases, When the vascular pedicle is dissect ed proximally to the perforating vein contained in the flap, the venou s drainage of both the deep and cutaneous systems can be restored by a nastomosis of only one vein: the cutanous or the radial comitant vein, On the other hand, the flap can be raised with the radial vessels (wi thout the cutaneous vein) at the start of surgery, and a large caliber cutaneous vein, such as the median cubital, the cephalic, or the basi lic, can be used for anastomosis in cases where the cutaneous veins in the distal forearm are too thin, or where the radial comitant vein is composed of two thin separated veins. We believe that preserving the perforating vein would make the forearm flap more reliable and more co nvenient in reconstructive surgery. (C) 1996 Wiley-Liss, Inc.