Finger Soft Tissue Reconstruction Using Arterialized Venous Free Flaps Having 2 Parallel Veins

reason, objective, purpose

Venous free flaps have been used for repair and coverage of digital soft tissue defects because they are simple and thin. When used as an arterialized venous free flap on a finger, the volar digital artery and dorsal vein of the recipient site are generally used. When the shape of the single vein within the arterialized venous free flap is straight, either the afferent or efferent vein may need to be redirected in order to connect to both the volar digital artery and dorsal vein. This redirection can sometimes necessitate a relatively long vascular pedicle that is prone to twisting. . To simplify this problem, the authors introduce a flap having two parallel veins.

materials used

The authors performed 44 arterialized venous free flaps having two parallel veins for the reconstruction of digital soft tissue defects between July 2002 and July 2004. The subjects included 37 male patients and 7 female patients with an age range from 17 to 71 (mean 42.2) years. The cause of the injuries included 32 machine injuries, 4 motor vehicle accidents, 4 tables saw injuries and 4 miscellaneous causes. The flap sizes ranged from 1x1 cm to 5.5x4.5 cm and the areas ranged from 1 cm2 to 24.8 cm2, averaging 6.5 cm2. The recipient finger included 6 thumb, 14 index, 9 long, 9 ring, and 6 small fingers. One case additionally included the reconstruction of the extensor tendon with palmaris graft. The donor site included the volar aspect of distal forearm in 35 cases, the thenar area in 8 cases, and the dorsal aspect of foot in 1 case. The vein distribution was determined by the use of a tourniquet. In the cases in which the venous distribution could not be easily identified, the proximal arm was wrapped with an esmarch to increase venous congestion. Vein distribution was marked with a skin marker and the region in which the afferent vein and the efferent vein were in parallel was selected. It is ideal to make the vein axis into a U shape for design of the arterialized venous flap. With respect to the size of blood vessels, veins that are suitable for the sizes of the finger vessels were selected (Fig.1). When no U shape configuration was found, a “Y”, “H” or “X” shape was selected and was eventually converted into a similar U shape or V shape by ligating the distal veins. That is, the Y shape configuration of vein was converted into a V shape by ligating the distal straight portion of the Y shape(Fig. 2), the H or X shape configuration of vein was converted into a similar U shape or V shape by ligating distal two straight portion of the H or X shape(Fig. 3). Additionally, successive double U shapes were sometimes created by ligating the distal straight veins of distal communicating branch of double U shape configuration(Fig. 4). The flaps were elevated to include the vein and a thin layer of subcutaneous fat. The donor sites were closed directly when the size of the flap was small. For larger flaps, the donor sites were covered with skin graft. The arteriovenous type free flap was used in all cases. The afferent vein was anastomosed to the volar digital artery, while the efferent vein was anastomosed to a dorsal digital vein. In 40 cases, one afferent vein and one efferent vein were connected; in 3 cases, one afferent vein and two efferent veins were connected; and in one case, two afferent veins and one efferent vein were connected. In 3 cases where two efferent veins were connected, the number of veins was increased by using Y-shaped efferent veins. The length of the afferent veins ranged from 0.5 cm to 3 cm, averaging 2.0 cm. When the size of the veins were small or their conditions were not ideal, long vascular pedicles were used. These pedicles were passed subcutaneously and the anastomosis was performed at a proximal site. Alprostadil(5㎍/day) and Asprin(300mg/day) were used to prevent occlusion of the vessel anastomosis for 1 week postoperatively.

operation date

2008-12-18

publication info

pubmed information available

presentation info

WSRM, Bueno Ires, Argentina