Free arterialised venous forearm flaps for intraoral reconstruction

In 29 patients, the intraoral defect after excision of an oral squamous cell carcinoma was repaired with an arterialised venous forearm flap. In all cases, a flap of skin and fat with a superficial vein passing through it was raised from the flexor surface of the right forearm. After the flap had been sutured into the intraoral defect, the original distal end of the vein was anastomosed to an artery and the original proximal end to a vein. Fifteen (52%) of the flaps survived completely, six (21%) had superficial epithelial loss or some marginal necrosis and eight (27%) became completely necrotic. Areas of partial loss developed slowly and formed stable granulation tissue. The flap donor sites were either closed primarily (n = 20) or were covered with a split thickness skin graft (n = 9). There were no functional problems of the donor forearms. These results contrast with the high success rates achieved with orthodox free radial forearm flaps. Further research into venous flaps is essential.