ABSTRACT
There is little information about long-term outcomes of flap transfer for treatment
of venous stasis ulcers in the lower extremity. Eleven patients who underwent free
and pedicled flap transfer for treatment of intractable venous stasis ulcers were
evaluated retrospectively. The operative procedures consisted of removal of the ulcer
and surrounding lipodermatosclerotic tissue, venous stripping, and flap transfer.
No ulcer recurrences in the territory of the transferred flap were identified for
a mean of 11 years during the follow-up period. However, four patients developed new
ulcers in the same leg after the flap transfer at 18, 24, 52, and 81 months. This
was probably the result of incomplete excision of surrounding lipodermatosclerotic
tissue. Three of four recurrent ulcers were healed with additional procedures. The
results of this study indicated that flap transfer combined with venous stripping
could lead to long-term healing of venous stasis ulcers. However, incomplete excision
of surrounding lipodermatosclerotic tissue caused new ulceration around the transferred
flap.
KEYWORDS
Venous stasis ulcer - lower extremity - flap
REFERENCES
- 1
Phillips T J, Dover J S.
Leg ulcers.
J Am Acad Dermatol.
1991;
25
965-987
- 2
Kikta M J, Schuler J J, Meyer J P et al..
A prospective, randomized trial of Unna's boots versus hydroactive dressing in the
treatment of venous stasis ulcers.
J Vasc Surg.
1988;
7
478-483
- 3
Darke S G, Penfold C.
Venous ulceration and saphenous ligation.
Eur J Vasc Surg.
1992;
6
4-9
- 4
Scriven J M, Hartshorne T, Thrush A J et al..
Role of saphenous vein surgery in the treatment of venous ulceration.
Br J Surg.
1998;
85
781-784
- 5
Gloviczki P, Bergan J J, Rhodes J M et al..
Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency:
lessons learned from the North American subfascial endoscopic perforator surgery registry.
The North American Study Group.
J Vasc Surg.
1999;
29
489-502
- 6
Allen R J, Celentano R, Dupin C et al..
Management of chronic venous insufficiency ulcers with free flaps: a case study.
Wounds.
1989;
1
193-197
- 7 Swartz W M. Free tissue transfers for intractable chronic venous ulcerations: a
long-term evaluation. In: Proceedings of the Annual Meeting of the American Association
of Plastic Surgeons, Scottsdale, AZ 1989 57; Abstract
- 8
Ramirez O M.
The effectiveness of the free muscle flap in the treatment of recalcitrant venous
stasis ulceration.
Plast Surg Forum.
1992;
15
77-78
- 9
Steffe T J, Caffee H H.
Long-term results following free tissue transfer for venous stasis ulcers.
Ann Plast Surg.
1998;
41
131-137
- 10
Dunn R M, Fudem G M, Walton R L, Anderson Jr F A, Malhotra R.
Free flap valvular transplantation for refractory venous ulceration.
J Vasc Surg.
1994;
19
525-531
- 11 Dunn R M, Rohrer M J, Vernadakis A J.
Management of venous ulceration: excision, skin grafting and microsurgical flaps. In: Ballard JL, Bergan JJ Chronic Venous Insufficiency. 1st ed. London; Springer-Verlag
2000: 125-138
- 12
Weinzweig N, Schlechter B, Baranicwski H et al..
Lower limb salvage in a patient with recalcitrant venous ulcerations.
J Reconstr Microsurg.
1997;
13
431-437
- 13
Weinzweig N, Schuler J.
Free tissue transfer in treatment of the recalcitrant chronic venous ulcer.
Ann Plast Surg.
1997;
38
611-619
- 14
Kumins N H, Weinzweig N, Schuler J J.
Free tissue transfer provides durable treatment for large nonhealing venous ulcers.
J Vasc Surg.
2000;
32
848-854
- 15
Isenberg J S.
Additional follow-up with microvascular transfer in the treatment of chronic venous
stasis ulcers.
J Reconstr Microsurg.
2001;
17
603-605
- 16
Watterson P A, Taylor G I, Crock J G.
The venous territories of muscles: anatomical study and clinical implications.
Br J Plast Surg.
1988;
41
569-585
- 17
Meyer V E, Butz P C, Smahel J et al..
Anatomy of the superficial venous system and the valves at the forearm and dorsum
of the foot: a microsurgical dissection study with special regard to vein segments
suitable as microvascular grafts.
J Reconstr Microsurg.
1991;
7
274. Abstract
- 18
Aharinejad S, Dunn R M, Fudem G M et al..
The microvenous valvular anatomy of the human dorsal thoracic fascia.
Plast Reconstr Surg.
1997;
99
78-86
- 19
Aharinejad S, Dunn R M, Nourani F et al..
Morphological and clinical aspects of scapular fasciocutaneous free flap transfer
for treatment of venous insufficiency in the lower extremity.
Clin Anat.
1998;
11
38-46
- 20
Yajima H, Tamai S, Ishida H et al..
Partial soleus muscle island flap transfer using minor pedicles from the posterior
tibial vessels.
Plast Reconstr Surg.
1995;
96
1162-1168
Kenji KawamuraM.D.
Department of Orthopaedic Surgery, Nara Medical University
840 Shijyo-cho, Kashihara, Nara 634-8522, Japan