Efficiency of Cephalic Vein Only Anastomosis During Radial Forearm Free Flap

Importance: The closure technique for the radial forearm free flap (RFFF), a commonly utilized flap in head and neck reconstruction, remains a debated topic as there are unique advantages and drawbacks to each technique. Objective: The present study aims to report on the outcomes of the closure of the RFFF with the superficial cephalic vein (CV)-only system in terms of venous compromise and flap survival. Methods (Design, Setting, Participants, Intervention, Measures): A retrospective review of patients who underwent head and neck reconstruction with RFFF between January 2015 and May 2021 at the authors’ institution was performed. Cases were categorized as superficial, dual, and deep systems. Multiple population and operative variables were collected for the study group. Results: In total, 221 cases of RFFF were included, of which 169 (76.5%) cases were performed using the CV alone, whereas the remaining 52 (22.5%) cases utilized either the dual or the deep system alone. The operative time in the superficial group was 265 minutes. There were 9 venous complications in the CV group, of which 5 required re-exploration in the operating room and 4 were treated conservatively. All venous-related flap complications were salvaged. Conclusion and Relevance: A majority of the RFFF cases could successfully be completed using the CV as the sole venous drainage, with high rates of flap survival, low complications, and low operative time.