Both superficial and deep extremity veins can be used successfully as the recipient site for free flaps

Many controllable factors can influence free flap success rates, including the choice of recipient vessels, which can be as crucial as selecting the optimum donor site. The extremities are unique in that their dual venous systems offer an even greater diversity of options and perhaps risks. Whether the superficial as well as the more conventional deep veins can be used successfully as the recipient vein site is an important question analyzed in this retrospective, nonrandomized, yet inclusive review of 102 free flaps from the past decade used only for extremity defects. During this 10-year period, 144 venous microanastomoses, including 41 using superficial recipient veins, were utilized for these 102 flaps. There were 10 anastomotic catastrophes (9.8%): half were venous in origin and four fifths were salvaged by prompt reexploration. Only one venous thrombosis, and that in the deep system, resulted in flap failure. All arterial problems in every patient resulted in total flap loss, so that overall there was a 94.2% flap success rate. The overall incidence of complications and flap failure when the deep vein was the recipient site was 9.6% and 5.5% respectively. For superficial veins it was 15.4% and 7.7%, and, if used in a combination for dual venous outflow, the incidence was 6.3% for either category. There was no significant difference in these rates between groups, and in the vast majority of cases either the deep or superficial venous systems could indeed be used successfully as the recipient vein for microvascular tissue transfers.