AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Seventy-Five Venous Flaps Transplanted to the Hand: As Reliable as Conventional Microvascular Transplants, Possibly Better
Darrell Brooks, MD, Rudolf F. Buntic, MD.
California Pacific Medical Center, San Francisco, CA, USA.

PURPOSE:
Reconstruction of thin, supple soft tissue cover is often a limiting factor in successful restoration of form and function to the hand. Use of local tissues is the standard because tissue is replaced “in kind.” When local tissue is not available, conventional tissue transplantation can provide reliable coverage. The result, however, can be bulky and pedicle diameter usually requires the surgery be extended through normal tissue to vessels at the distal wrist further challenging the aesthetic outcome. The venous flap (Vf) is a source of extremely thin tissue similar to that covering the hand. It is nourished by blood flow into the venous system and therefore has no associated arterial donor morbidity. A vein that can be seen can be used to design a flap on the overlying skin to custom fit both defect and target vessel diameter. The purpose of this study is to present our approach to reliable soft tissue cover of the hand utilizing the Vf in cases where local tissue is insufficient and to highlight its benefits relative to conventional transplants.
METHODS:
A retrospective study between 6/2000 and 7/2007 involved 75 Vf transplanted to the hand. The flaps were classified based on their placement between in-flow and outflow vessels. A Vf placed between two arteries would be designated as AVfA, an artery and vein as AVfV, or two veins as VVfV. A flap placed between an artery and three outflow veins was designated AVfV3 (Figure 1). A flap with two separate vascular circuits was indicated with a backslash between them. For example, a flap used to reconstruct the digital artery and dorsal vein was designated AVfA/VVfV. Flaps were designed with multiple in-flow and outflow vessels to insure the reliability of the larger flaps, or to reconstruct multiple digital vessels. Donor sites included SAPH (saphenous vein), CEPH (cephalic vein), VPF (volar proximal forearm), VDF (volar distal forearm), DH (dorsal hand), and DF (dorsal finger).
RESULTS:
Seventy-three of 75 flaps survived (97.3%). The flaps were classified as AVfA (36), AVfV (24), AVfVx (6), AVfAx (5), AVfA/VVfV (3), VVfV (1). Vf failures were both AVfV in design. The donor site was the VDF in 86.6%, VPF in 6.6%, SAPH in 4%, DH in 1.3% and the DF in 1.3% of cases. Flap size ranged from 2X2cm to 9X6cm. Vf veins could be designed to match the diameter of target arteries and veins regardless of location.
CONCLUSION:
Venous flaps can provide reliable coverage for small and medium sized soft tissue defects of the hand. Versatility of Vf vein length, pattern, and diameter allows innovative designs which can be used to reconstruct the most complex soft tissue and vascular defects. Success rates were comparable to conventional free flaps, but with less morbidity.
FIGURE 1:
Resultant contour of a venous flap (AVfV3) used to resurface a 9X6 cm defect over the dorsum of the right thumb.


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