SINGLE VERSUS DUAL VENOUS DRAINAGE OF THE RADIAL FOREARM FREE-FLAP

Purpose: To compare single versus dual venous drainage of radial forea rm free flaps (RFFF) and its impact on flap survival. Design: A retros pective case series of 43 consecutive patients undergoing radial forea rm free flap reconstruction for head and neck cancer defects, combined with a meta-analysis of 218 reported cases. Setting: Two academic, te rtiary referral medical centers. Intervention: All 43 RFFF's were harv ested and inset in a similar fashion. In 16 patients (group 1), two ve nous anastomoses were performed. In 27 patients (group 2) one anastomo sis was created. The arterial anastomosis was similar in both groups. Outcome Measures: Clinically noted viability of the radial forearm fre e flap over the first 6 postoperative weeks. Results: All 43 RFFFs mai ntained complete viability. No flap loss, complete or partial, was ide ntified. Two patients in group 1 and one patient in group 2 developed postoperative pharyngocutaneous fistulae, but complete healing occurre d with local wound care. One patient in group 2 developed a postoperat ive neck hematoma, which was evacuated with no insult to the free flap . Single venous anastomosis shortened operative time by 21 to 36 minut es. Conclusion: Though two venous anastomoses may provide a more fail- safe mechanism for adequate venous drainage, a single venous anastomos is employing a subcutaneous vein provides adequate drainage with reduc ed operative time and no additional morbidity. Meta-analysis statistic ally confirmed the equivalency of single and dual venous amastimoses w ith respect to flap survival. Copyright (C) 1996 by W.B. Saunders Comp any.