title: Double fat plane of the radial forearm free flap and its implications for the microvascular surgeon.
abstract: OBJECTIVE
  The radial forearm free flap (RFFF) is a workhorse in reconstruction of head and neck defects. The superficial cephalic vein is used most commonly for microvascular anastomosis; however, this vein has a variable course in the subcutaneous tissues. We have routinely isolated the cephalic vein within a reliable double fat plane, which has not been previously described. This study demonstrates the consistency of the cephalic vein within this double fat plane using a cadaveric model and our prospective operative experience raising the RFFF.
  
  
  METHODS
  Four lightly preserved cadavers and one fresh cadaver were dissected by elevating a RFFF, identifying the double fat plane, and isolating the cephalic vein within this plane. Between August 2006 and April 2008, we prospectively recorded the anatomic location of the cephalic vein in 35 patients who had RFFF surgery.
  
  
  RESULTS
  The double fat plane and cephalic vein were identified in all cadaveric dissections. The double fat plane was identified and led to injury-free dissection of the cephalic vein in all 35 patients.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of the presence of the double fat plane within the subcutaneous tissue of the radial forearm and its use as a consistent landmark in finding the cephalic vein. Our cadaveric studies and operative observations have demonstrated that the double fat plane is a reliable, consistent, and helpful guide for the isolation of the cephalic vein in RFFF surgery.
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Ali
authors.initials: A
authors.lastname: Shahnavaz
authors.forename: Chady
authors.initials: C
authors.lastname: Sader
authors.forename: Eric
authors.initials: E
authors.lastname: Henry
authors.forename: Jonathan R B
authors.initials: JR
authors.lastname: Trites
authors.forename: S Mark
authors.initials: SM
authors.lastname: Taylor
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
authors.forename: Jeffery
authors.initials: J
authors.lastname: Harris
authors.forename: Robert D
authors.initials: RD
authors.lastname: Hart
mesh_terms: D000273:Adipose Tissue; D005542:Forearm / Q000098:blood supply* / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D011884:Radius / Q000098:blood supply* / Q000601:surgery*; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000379:methods*; D014680:Veins / Q000601:surgery*