Survival of a free radial forearm flap without venous return

The radial forearm free flap is an ideal transfer for intraoral reconstruction because of its large vessels and pliable nature. In the case presented, a proximally-based forearm flap was transferred for reconstruction of an intraoral defect in the buccal and retromolar region after carcinoma resection, but there was no venous flow from either cephalic vein or venae comitantes following completion of the arterial anastomosis. In order to reduce the congestion in the flap, an end-to-end anastomosis between the distal end of the radial artery and the ipsilateral lingual vein was performed. Despite the absence of venous return, flap survival was complete.