Vein Selection for Optimal Flap Outcomes in the Radial Forearm Free Flap: A Systematic Review and Meta-Regression

Abstract

Background: Radial forearm free flaps represent a workhorse reconstructive modality in microsurgical rehabilitation. The reliable anatomy, availability of thin, pliable tissue, and a long pedicle afford the surgeon a significant latitude of reconstructive freedom, allowing this flap to be useful for a multitude of body sites. Although the arterial anatomy is straightforward, the venous outflow of the flap is generally through a circuit utilizing a superficial, deep, and united venous system. This has allowed surgeons a variety of venous options to utilize, but has also generated debate in the community regarding the optimal vessel choice. This manuscript seeks to examine published studies in the literature in an effort to determine if a statistically significant difference exists among venous outflow options as they lead to microsurgical success. Methods: A systematic review and meta-regression were conducted examining 14 studies with a total of 1182 radial forearm flaps. A university-based statistician was recruited to perform a detailed analysis of the results. Results: Results show that there is no statistically significant difference in flap outcomes among the superficial, deep, and united venous drainage systems when outflow is deemed to be favorable intraoperatively. Conclusions: The choice of venous outflow system does not impact outcomes of the radial forearm flap. Surgeon preference, technical skill, and patient anatomy should be the guiding factors in determining vein choice so long as the venous outflow is favorable.