ABSTRACT
When there is not sufficient local tissue available for reconstruction of one or multiple
digital defects, distant flap reconstructions are required. Available thin flaps with
defined arterial inflow and venous outflow are limited and require the sacrifice of
an arterial pedicle. In addition, a functional limitation can occur at the donor site.
During the last decades, experimental and clinical attempts have been made in using
venous flaps, based just on the venous network for in- and outflow. A 40-case series
of arterialized venous free flaps in soft-tissue reconstruction of the digits and
hand is presented. Neovessel formation induced by an intact venous plexus within the
flap proved clinically to be the survival mechanism. Postoperative congestion was
present in all flaps and subsided within 14 days; 92 percent of all flaps eventually
survived. In 57.5 percent of cases, total flap survival was observed; in 17.5 percent
of flaps, a superficial epidermolysis occurred, not requiring further surgery; in
17.5 percent of flaps, a full-thickness skin necrosis developed, requiring grafting
(minor complication); in 7.5 percent of reconstructions, total flap necrosis was observed.
Thus, in the authors' experience, when conventional local flaps are not available,
arterialized venous free flaps proved to be a successful solution for soft-tissue
reconstruction in digits and hands. The authors present the main indications and advantages
of arterialized venous free flaps, emphasizing the essential technical steps and the
most frequent pitfalls in treatment.
KEYWORDS
Arterialized venous flaps - digital and hand soft-tissue defects - repair
