Floor plan - 2013 Annual Meeting - American Association for Hand ...

Refinement of Arterialized Venous Flaps in Finger Reconstructions
Institution where the work was prepared: Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
Yu-Te Lin, MD, MS; Chih-Hung Lin; Cheng-Hung Lin; Fc Wei, MD, FACS; Chang Gung Memorial Hospital
INTRODUCTION:
Venous flaps had been broadly applied in hand/finger reconstruction and been classified according to different afferent vessels. Though
arterialized venous flap was proposed superior to other styles of venous flaps in the literatures, venous congestion seemed to be predestinated
in most observations. Partial loss of the flap was considered a “normal” finding during the first few days after arterialization.
The unfavorable results may not affect the general outcomes of wound healing. Nevertheless, scarring and fibrosis does affect the functional
outcomes of reconstructed fingers/hands. Refinement of the arterialized venous flaps was intended.
MATERIALS/METHODS:
From May 2005 to Apr 2006, seven arterialized venous flaps were used for six acutely traumatized fingers and one reconstruction after
release of a finger contracture. All venous flaps were arterialized in an orthodromic pattern. One to two veins were repaired according
to the veins included in the flaps. Technique of refinement was to decrease intravascular pressure of the drainage vein by interfering
arterial flow-through with a hemoclip. Clipping the communicating branch of H-shaped veins was performed in 3 patients; Clipping a
limb ofë-shaped vein at the bifurcation or clipping at the midway of a flow-through arterialized vein were done in 4 patients. Flaps were
monitored in the Microsurgical Intensive Care Unit for 5 to 7 days. The patients received hand therapies and were followed in the clinics
for 6 months.
RESULTS:
No venous congestion of the flap was detected during the early postoperative course. Flaps were observed mimicking conventional
arterial flaps in color and texture. Scarce congestion was noted in one case during postoperative 3rd to 7th day, and subsided without
any loss. One vasospasm with arterial insufficiency was detected in one case and re-do arterial anastomosis was done. Mild to moderate
venous congestion was relieved in 10 days with superficial loss on the margin. No contraction of flap was observed and adequate
hand function was obtained in all cases.
DISCUSSION:
A vein with diversion of arterial blood provided a venous blood pressure for venous drainage, which decreased the venous congestion
of the flaps. Expression of scarce venous congestion starting at 3rd postoperative day may be due to dilatation of choke vessels after
arterialization. Flap survival mimicking an arterial flap makes the refined flaps reliable in hand and finger reconstructions.
Arterialized Venous Instep Flap: A New Alternative for Reconstruction of Palmar Contracture
Release
Institution where the work was prepared: Gulhane Military Medical Academy, Ankara, Turkey
Fatih Zor; Selçuk Isik; Muhidtin Eski; Serdar Ozturk; Gülhane Military Medical Academy
Palmar contractures cause great difficulty in performing the tasks required in daily life. A wide variety of flaps have been used for hand
reconstruction and each has its own advantages and disadvantages. As a general rule of plastic surgery, all losses must be replaced by
kind. So plantar region seems to be a good alternative. Medial plantar flap has been used in the literature but, it is a bulk flap and sacrifices
a major artery. In this study, arterialized venous instep flap is described, and used in a clinical series. The amount of tissue loss is
first determined, and the appropriate dimensions of the skin island of the flap are designed on the non-weight bearing area of the foot.
The skin island of the flap resembles medial plantar flap. The thin skin flap is then elevated by preserving the subdermal plexus. At the
distal edge of the skin island, 2or3 subcutaneous veins are preserved and harvested. At the proximal edge of the flap, saphenous vein
is preserved and included in the flap. Following subcutaneous dissection the skin island is transferred to the defect. Following preparation
of the digital arteries, one of the veins at the distal edge of the flap is anastomosed to the digital arteries and the vein at the proximal
edge is anastomosed to the dorsal veins of the hand. Between January 2006-June 2007, 5 arterialized venous instep flaps were
performed. The flap dimensions were averagely 3x 5 cm. All flaps survived without any significant problem. The mean follow-up period
was 6 months. Functional results were satisfactory in all cased. Protective sensation was recognized about 3-6 months postoperatively.
None of the flaps required defatting in follow-up period. Arterialized venous instep flap is very thin as it lacks fascia, it is easily
harvested and no major artery is sacrificed. Moreover characteristics of plantar skin is very similar to palmar skin which causes a great
advantage to this flap. Although further studies are required, we think that the use of arterialized venous instep flap is a very useful
method for reconstruction of the palm.
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