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CC BY 4.0 · Arch Plast Surg 2023; 50(06): 568-572
DOI: 10.1055/a-2122-6029
Hand/Peripheral Nerve
Case Report

Venous Free Flap with Interposition Bypass Graft for Arteriovenous Fistula Preservation: A Case Report

Cyril Awaida 
1   Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
,
Marion Aribert 
1   Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
,
Natalie Weger 
2   Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Kendall Keck 
2   Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Andrei Odobescu 
3   Department of Plastic Surgery, University of Texas-Southwestern, Dallas, Texas
› Author Affiliations Funding None.
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Abstract

Cutaneous squamous cell carcinoma (CSCC) overlying an arteriovenous fistula (AVF) is rare and presents unique challenges. This case report describes a method of fistula preservation after CSCC excision using a flow-through venous free flap. The saphenous vein of the venous flap was used as flow-through segment for AVF preservation. The flap was inserted along the dorsal aspect of the forearm wound and microvascular anastomosis of the arterial inflow was completed using a vein just proximal to the radiocephalic fistula anastomosis. Venous outflow was established by creating an end-to-end vascular anastomosis between the cephalic vein and the greater saphenous vein. A separate subcutaneous vein was used to provide a low-pressure outflow for the flap to avoid congestion. This case demonstrates an option for AVF preservation that has not been previously described. It also highlights the importance of a multidisciplinary approach for the safe treatment of CSCCs overlying AVFs.

Keywords

arteriovenous fistula - saphenous vein - squamous cell carcinoma - venous free flap

Authors' Contributions

The authors confirm contribution to the paper as follows: study conceptualization: A.O. and N.W.; data curation: M.A., K.K.; writing—review and editing: C.A. All authors reviewed and approved the final version of the manuscript.


Ethical Approval

This case report was exempted form institutional review board (IRB) approval form the IRB Board of University of Iowa.


Patient Consent

Informed consent was obtained for all patient images and information included in this case report.




Publication History

Received: 29 December 2022

Accepted: 27 June 2023

Accepted Manuscript online:
04 July 2023

Article published online:
12 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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