Reliability of the venae comitantes in venous drainage of the free radial forearm flaps

The radial venae comitantes are usually considered as an accessory venous outflow tract in the free radial forearm flap because of their smaller size and thinner structure when compared with those of the cephalic vein. To evaluate the reliability of the deep venous system, a single radial vena comitans anastomosis was performed to serve as the sole venous outflow tract in 94 consecutive radial forearm free flap transfers. The suprafascial dissection technique was used in flap elevation, which allowed preservation of the cephalic vein and the dorsal branch of the radial nerve. In all cases, the external diameter of at least one vena comitans was adequate (less than or equal to 1.5 mm) to perform a smooth microvascular anastomosis; in none of the cases was a venous anastomosis failure detected. Preselected use of a single vena comitans for the venous drainage of radial forearm free flaps was proven to be reliable and was preferred because of the ease of flap dissection and better donor site appearance.