Comparison of Venous Thrombosis in Different Venous System for Anastomosis in Radial Forearm Free Flap: A Systematic Review and Meta-Analysis

Main Article Content

Dheeratt Choengprapakorn
Pattaramon Rattanaphan
Porjai Pattanittum
Aungkana Klungtong


Radial forearm free flap is workhouse flap for oral soft tissue and tongue reconstruction after head and neck cancer ablation. Free flaps failure has many factors contribute but venous thrombosis is the most common cause in many studies. Venous system for venous anastomosis in radial forearm free flap still controversy. This study was systematic review and meta-analysis aim to compare venous thrombosis in different venous system for venous anastomosis in radial forearm free flaps by searching in PubMed, Cochrane library, ScienceDirect, Google scholar and Clinical database which studied in venous compromised after radial forearm free flap. Publication bias and sensitivity analysis were also assessed. 2,075 cases in 8 studies were included in this study. The dual anastomosis group tend to be lower incidence of venous compromise compare to cephalic anastomosis group (RR=0.62, 95% CI 0.35-1.08, M-H, Fixed) and venae comitans anastomosis group (RR=0.59, 95% CI 0.15-2.33, M-H, Random). However, the difference was not statistically significant. The incidence of venous thrombosis in venae comitans anastomosis group has lesser than cephalic group with significant difference (RR= 2.02, 95% CI 1.22-3.36, M-H, Fixed). This meta-analysis suggested the dual anastomosis has better outcome compares to another system but not statistically significant.


Download data is not yet available.

Article Details

How to Cite
Choengprapakorn D, Rattanaphan P, Pattanittum P, Klungtong A. Comparison of Venous Thrombosis in Different Venous System for Anastomosis in Radial Forearm Free Flap: A Systematic Review and Meta-Analysis. Khon Kaen Dent J [Internet]. 2022 Jul. 11 [cited 2022 Oct. 5];25(2):38-49. Available from:
Research Articles
Share |


Yang GF, Chen PJ, Gao YZ, Liu XY, Li J, Jiang SX, et al. Classic reprint Forearm free skin flap transplantation: a report of 56 cases. Br J Plast Surg 1997;50(3):162-5.

Timmons MJ. The vascular basis of the radial forearm flap. Plast Reconstr Surg 1986;77(1):80-92.

Futran ND, Gal TJ, Farwell DG. Radial forearm free flap. Oral and Maxillofacial Surgery Clinics 2003;15(4):577-91.

Khashaba AA, McGregor IA. Haemodynamics of the radial forearm flap. Br J Plast Surg 1986; 39(4):441-50.

Imanishi N, Nakajima H, Aiso S. Anatomic study of the venous drainage architecture of the forearm skin and subcutaneous tissue. Plast Reconstr Surg 2000;106(6):1287-94.

Ichinose A, Tahara S, Terashi H, Yokoo S, Nakahara M, Hashikawa K, et al. Importance of the deep vein in the drainage of a radial forearm flap: a haemodynamic study. Scand J Plast Reconstr Surg Hand Surg 2003;37(3):145-9.

Zhai QK, Dai W, Tan XX, Sun J, Zhang CP, Qin XJ. Proper Choice of Donor Site Veins for Patients Undergoing Free Radial Forearm Flap Reconstruction for the Defects of Head and Neck. J Oral Maxillofac Surg 2018;76(3):664-9.

Liu Y, Jiang X, Huang J, Wu Y, Wang G, Jiang L, et al. Reliability of the superficial venous drainage of the radial forearm free flaps in oral and maxillofacial reconstruction. Microsurgery 2008;28(4):243-7.

Futran ND, Stack BC, Jr. Single versus dual venous drainage of the radial forearm free flap. Am J Otolaryngol 1996;17(2):112-7.

The Ottawa Hospital (homepage on the internet). Ottawa: (update 2020 December 18 cited 2021 January 21) The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. Available from demiology/oxford.assp

SHI Rong-hua ZY-f, LIU Yuan, WU Yang, HUANG Jian-tao, CHENG Xiao-qing. Superficial versus deep venous drainage of the radial forearm free flaps. J Oral Maxillofac Surg 2012;22(4):252-6.

Ichinose A, Tahara S, Yokoo S, Omori M, Miyamura S, Tsuji Y, et al. Fail-safe drainage procedure in free radial forearm flap transfer. J Reconstr Microsurg 2003;19(6):371-6.

Ichinose A, Terashi H, Nakahara M, Sugimoto I, Hashikawa K, Nomura T, et al. Do multiple venous anastomoses reduce risk of thrombosis in free-flap transfer? Efficacy of dual anastomoses of separate venous systems. Ann Plast Surg 2004; 52(1):61-3.

Liu Y, Zhao YF, Huang JT, Wu Y, Jiang L, Wang GD, et al. Analysis of 13 cases of venous compromise in 178 radial forearm free flaps for intraoral reconstruction. Int J Oral Maxillofac Surg 2012; 41(4):448-52.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine 2009;6(7):e1000097.

Mohanty N, Nayak B. Single cephalic vein as the only draining vein of radial forearm free flap: A comparative study of 154 cases. Nigerian J Plast Surg 2015;11(2):40-4.

Kim YC, Kim MJ, Kim HB, Kim SC, Choi JW. Impact of Venous Outflow Pattern on Flap Compromise in Head and Neck Reconstruction: Review of 309 Radial Forearm Free Flaps. J Craniofac Surg 2019; 30(4):1194-7.

Selber JC, Sanders E, Lin H, Yu P. Venous drainage of the radial forearm flap: comparison of the deep and superficial systems. Ann Plast Surg 2011;66(4):347-50.

Alan Turner MJ, Smith WP. Double venous anastomosis for the radial artery forearm flap. Improving success and minimising morbidity. J Craniomaxillofac Surg 2009;37(5):253-7.

Ueda K, Harashima T, Inoue T, Hatoko M, Tanaka I, Shidara Y. Analysis of 75 forearm flaps. Eur J Plast Surg 1991;14(4):177-80.

Médard de Chardon V, Balaguer T, Chignon-Sicard B, Riah Y, Ihrai T, Dannan E, et al. The radial forearm free flap: a review of microsurgical options. J Plast Reconstr Aesthet Surg 2009; 62(1):5-10.

Netscher DT, Sharma S, Alford EL, Thornby J, Leibman NS. Superficial versus deep: options in venous drainage of the radial forearm free flap. Ann Plast Surg 1996;36(5):536-41.

Martin D, Bakhach J, Casoli V, Pellisier P, Ciria-Llorens G, Khouri RK, et al. Reconstruction of the hand with forearm island flaps. Clin Plast Surg 1997;24(1):33-48.

Demirkan F, Wei FC, Lutz BS, Cher TS, Chen IH. Realibility of the venae comitantes in venous drainage of the free radial forearm flaps. Plast Reconstr Surg 1998;102(5):1544-8.

Patel SA, Pang JH, Natoli N, Gallagher S, Topham N. Reliability of venous couplers for microanastomosis of the venae comitantes in free radial forearm flaps for head and neck reconstruction. J Reconstr Microsurg 2013;29(7):433-6.

Shima H, Ohno K, Michi K, Egawa K, Takiguchi R. An anatomical study on the forearm vascular system. J Craniomaxillofac Surg 1996;24(5):293-9.

Ichinose A, Tahara S, Terashi H, Nomura T, Omori M. Short-term postoperative flow changes after free radial forearm flap transfer: Possible cause of vascular occlusion. Ann Plast Surg 2003;50(2):160-4.

Riot S, Herlin C, Mojallal A, Garrido I, Bertheuil N, Filleron T, et al. A Systematic Review and Meta-Analysis of Double Venous Anastomosis in Free Flaps. Plast Reconstr Surg 2015;136(6):1299-311.

Bai S, Xu ZF, Duan WY, Liu FY, Huang DH, Sun CF. Single superficial versus dual systems venous anastomoses in radial forearm free flap: a meta-analysis. PLOS One 2015;10(8):e0134805.

Xie Y, Feng T, Ou Y, Lin Y, Gong W, Wang Y. Superficial versus deep system single venous anastomosis in the radial forearm free flap: a meta-analysis. Int J Oral Maxillofac Surg 2021; 50(7):873-78.