REFINEMENT OF SURGICAL PROCEDURES IN RADIAL FOREARM FREE FLAP TRANSFER

Abstract

We have carried out about 600 head and neck reconstructions with radial forearm free flap transfer and basic/clinical studies on flap circulation and surgical procedures. Knowledge obtained and refinement of surgical procedures in flap elevation, venous anastomosis and donor site coverage introduced at Kobe University Hospital are as follows:
1) Deep and superficial venous systems of the flap are connected by including the cubital perforating vein in the venous pedicle.
2) Our studies have revealed that the deep venous system has dominant blood flow compared with the superficial system. Consequently, drainage of the former system is crucial in reducing venous disturbance of the flap.
3) “Network venous anastomosis”, where the two separate venous systems of the flap are anastomosed with the two venous systems of the neck (the internal and external jugular veins) including their connecting perforating vein, imitates the anatomical venous drainage in the forearm, providing a reliable, fail-safe drainage system.
4) Skin grafts preserving subdermal vascular networks provide aesthetically more optimal results in covering the donor site of the flap.
5) Fixation of skin grafts to the donor site of the flap with polyurethane foam and film without using the tie-over procedure is an easy and time-saving method requiring no assistants.