Role of the perforating vein in vascular pedicle of free forearm flap.

An innovation in the preparation of the vascular pedicle of the free radial forearm flap is presented. While the radial artery is commonly used as the arterial pedicle of the flap, either the cutaneous venous system or the radial comitant vein (deep venous system) is used as the venous pedicle. The perforating vein communicates between these two venous systems at the cubital fossa, and we confirmed its presence in all but one of more than 180 cases. When the vascular pedicle is dissected proximally to the perforating vein contained in the flap, the venous drainage of both the deep and cutaneous systems can be restored by anastomosis of only one vein: the cutaneous or the radial comitant vein. On the other hand, the flap can be raised with the radial vessels (without the cutaneous vein) at the start of surgery, and a large caliber cutaneous vein, such as the median cubital, the cephalic, or the basilic, can be used for anastomosis in cases where the cutaneous veins in the distal forearm are too thin, or where the radial comitant vein is composed of two thin separated veins. We believe that preserving the perforating vein would make the forearm flap more reliable and more convenient in reconstructive surgery.