Fail-safe drainage procedure in free radial forearm flap transfer

The reliability of the free radial forearm flap is widely accepted; however, postoperative venous thrombosis still occurs occasionally. Thus, establishment of a fail-safe drainage system has been a challenging frontier. A total of 405 consecutive free radial forearm flap transfers, carried out in the authors' department between 1987 to 2002, were reviewed retrospectively. The most reliable drainage method comprised the dual flap drainage veins of the superficial venous system (the cutaneous vein) and the deep system (the radial vena comitans), including their connecting cubital perforating vein, and the two neck recipient veins of the internal jugular and the external jugular venous systems. None of the flaps transferred by this method incurred venous failure, regardless of the surgeons conducting the operation. This study on the venous network in drainage systems of the free radial forearm flap demonstrated that the described method functions in a self-sustaining manner, and contributes to protection against venous catastrophe.