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

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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.


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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 Dec. 5];25(2):38-49. Available from:
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