Anatomical consideration for the venous drainage of the reverse-flow island flaps in the extremities (in the upper versus in the lower extremity)

Summary

In order to obtain information about the mechanism of the venous drainage in reverse-flow island flaps in the extremities, we dissected 10 radial, 10 peroneal, 10 anterior tibial, and 10 posterior tibial arteries and veins in cadavers. We examined the cutaneous perforators nourishing those flaps, venous valves, communicating branches and collateral branches of the accompaning veins, then calculated whether or not there was a smooth reverse venous flow in relation to the above locational relationship. From these findings, in almost all reverse-flow island flaps, there are some valves so located as to block the reverse venous flow in the accompaning veins. This induces us to consider that some valves, not all, would be incompetent for the reverse venous flow to take place in the reverse-flow flap. In some clinical cases, however, some valves would be so competent as to block the reverse venous flow. A comparison between the radial and the peroneal accompaning vein suggests that the reverse venous flow in the lower extremity is more disturbed than in the upper extremity.