Article
Modified arterialized venous flap for the reconstruction of 12 digits
Search Medline for
Authors
-
Jing Chen
- Affiliated Hospital of Nantong University, Nantong, China
-
Jun Tan
- Affiliated Hospital of Nantong University, Nantong, China
-
Qing Zhong Chen
- Affiliated Hospital of Nantong University, Nantong, China
-
Jin Bo Tang
- Affiliated Hospital of Nantong University, Nantong, China
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: The key to improving the survival rate of the arterialized venous flap is to ensure a good venous return to reduce venous congestion. To mitigate the problem, we designed modified flaps to restrict shunting and aimed to report our clinical experience and outcomes.
Methods: We performed 12 arterialized free venous flaps in 12 patients for digital reconstruction using our modified method between February 2017 and March 2018. The mean age was 41 (range 24-74) years old. The mean area of flaps was 14 (range 5-30) cm2. The number of venous pattern of flaps was 5 (II-pattern) and 7 (H-pattern), respectively. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. The length of proximal vein pedicles was depended on the recipient site. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. We usually select the thinner vein as the arterialized vein, which was anastomosed in a retrograde manner, with the inflow running against the valves. The other vein was anastomosed with the superficial vein of digit. Close postoperative monitoring is performed. Routine postoperative anticoagulant therapy is used. The patients were followed.
Results and Conclusions: The average operation time was 101 (range 75-150) minutes. The average follow-up time was 10 (range 6-16) months. All flaps survived entirely. The wounds of donor sites were sutured directly except one case. The color, turgor, temperature of 5 flaps resemble the conventional arterial flaps after operation and during follow-up. Seven flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided in 7-10 days after operation. At the final follow-up, the appearance of the flap had no difference with those usually observed in arterial flaps.
Arterialized free venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improved survival rate. The flap constitutes an ideal donor to repair a small or medium-sized defect of the hand.
