Selber Jesse C, Sanders Elizabeth, Lin Heather, Yu Peirong
Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA.
Ann Plast Surg. 2011 Apr;66(4):347-50. doi: 10.1097/SAP.0b013e3181f46631.
The purpose of this study is to compare complications between the superficial and deep venous drainage systems of the free radial forearm flap to aid in selection of venous drainage in a commonly used flap.
A retrospective cohort of 370 radial forearm free flaps performed between 1998 and 2008 were reviewed. Multiple population and outcome variables were compared among outcome groups. A technique was implemented to explore the venae comitantes at the wrist crease to determine their adequacy before a full-scale flap elevation.
There were a total of 21 venous complications requiring re-exploration (5.7%) and 5 flap failures (1.4%). The incidence of inadequate venous outflow was 2.2% when the venae comitantes were used alone and adding a cephalic vein for drainage salvaged half of the flaps. The incidence of inadequate venous outflow was 3.8% when the cephalic vein was used alone and adding a venae comitans for drainage salvaged all the flaps.
The problem of inadequate outflow in the radial forearm flap is more commonly seen when selecting the cephalic vein, or using both the deep and superficial systems together. When of adequate caliber, the venae comitantes should be selected as the sole venous outflow for this flap.
本研究旨在比较游离桡侧前臂皮瓣浅静脉和深静脉引流系统的并发症，以辅助选择常用皮瓣的静脉引流方式。
回顾性分析1998年至2008年间进行的370例桡侧前臂游离皮瓣手术。对不同结局组的多种人群和结局变量进行比较。采用一种技术在腕横纹处探查伴行静脉，以在全面掀起皮瓣前确定其是否合适。
共有21例静脉并发症需要再次探查（5.7%），5例皮瓣失败（1.4%）。单独使用伴行静脉时静脉流出不足的发生率为2.2%，添加头静脉进行引流挽救了一半的皮瓣。单独使用头静脉时静脉流出不足的发生率为3.8%，添加伴行静脉进行引流挽救了所有皮瓣。
在选择头静脉或同时使用深浅静脉系统时，桡侧前臂皮瓣静脉流出不足的问题更为常见。当管径足够时，应选择伴行静脉作为该皮瓣的唯一静脉流出道。
