25 years of forearm free flaps – 1 vein or 2?
Reviewed by Stuart Clark

This is a prospective 25-year study from 1998 to 2023 of 368 forearm free flaps, 314 of which were radial and 54 ulnar in 364 patients. Of these, 68 had 1 venous anastomosis whilst 238 had 2. These were assessed on a background of the common cause of vascular compromise being venous. Flap failure ranging from 5–7.5% was noted, and of these compromised flaps, 69-76% are reported to be salvageable through surgical vascular revision. In this study, 13 (4.2%) required revision of which 7 were thought to be venous, 3 arterial and 3 a combination of both. They noted there was a significantly higher surgical revision rate in the group with 1 venous anastomosis, 6 flaps (8.8%) whilst 2 venous anastomoses accounted for 7 flaps (2.9%). It was unclear what the potential benefit was of using the deep system concomitant vein against the superficial system. They noted that neither age nor flap type was associated with revision or flap failure. The implication is that 2 venous anastomoses may be preferable.

Free forearm flaps for head and neck reconstruction: fewer revisions and flap failures with two venous anastomoses – a 25 year prospective study.
Kuijpers CJ, Van Cann EM, Deileman FJ, et al.
INT J ORAL MAXILLOFAC SURG 
2026;55(2):152–8.