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Clinical applications of venous flaps in the reconstruction of hands and fingers

  • Trauma Surgery
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Abstract

In recent years, the venous flap has been highly regarded in microsurgical and reconstructive surgeries, especially in the reconstruction of hand and digit injuries. It is easily designed and harvested with good quality. It is thin and pliable, without the need of sacrificing a major artery at the donor site, and has no limitation on the donor site. It can be transferred not only as a pure skin flap, but also as a composite flap including tendons and nerves as well as vein grafts. All these advantages make it an optimal candidate for hand and digit reconstruction when conventional flaps are limited or unavailable. In this article, we review its classifications and the selection of donor sites, update its clinical applications, and summarize its indications for all types of venous flaps in hand and digit reconstruction.

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References

  1. Lai-jin L, Xu G (2006) The reverse dorsal metacarpal flap: experience with 153 cases. Ann Plast Surg 56(6):614–617

    Article  PubMed  Google Scholar 

  2. Kateva M, Dimitrov K (2008) Neurocutaneous metacarpal flaps. Acta Chir Plast 50(3):89–92

    CAS  PubMed  Google Scholar 

  3. Atasoy E (1982) Reversed cross-finger subcutaneous flap. J Hand Surg Am 7(5):481–483

    CAS  PubMed  Google Scholar 

  4. Soucacos PN, Zoubos AB, Korompilias AV, Vekris MD (2008) Versatility of the island forearm flap in the management of extensive skin defects of the hand. Injury 39(Suppl 3):S49–S56

    Article  PubMed  Google Scholar 

  5. Yii NW, Elliot D (1994) Dorsal V-Y advancement flaps in digital reconstruction. J Hand Surg Br 19(1):91–97

    Article  CAS  PubMed  Google Scholar 

  6. Honda T, Nomura S, Yamauchi S, Shimamura K, Yoshimura M (1984) The possible applications of a composite skin and subcutaneous vein graft in the replantation of amputated digits. Br J Plast Surg 37(4):607–612

    Article  CAS  PubMed  Google Scholar 

  7. Nishi G, Shibata Y, Kumabe Y, Hattori S, Okuda T (1989) Arterialized venous skin flaps for the injured finger. J Reconstr Microsurg 5(4):357–365

    Article  CAS  PubMed  Google Scholar 

  8. Fasika OM, Stilwell JH (1993) Arterialized venous flap for covering and revascularizing finger injury. Injury 24(1):67–68

    Article  CAS  PubMed  Google Scholar 

  9. Cheng TJ, Chen HC, Tang YB (1996) Salvage of a devascularized digit with free arterialized venous flap: a case report. J Trauma 40(2):308–310

    Article  CAS  PubMed  Google Scholar 

  10. Nakazawa H, Kikuchi Y, Honda T, Isago T, Morioka K, Itoh H (2004) Use of an arterialised venous skin flap in the replantation of an amputated thumb. Scand J Plast Reconstr Surg Hand Surg 38(3):187–191

    Article  PubMed  Google Scholar 

  11. Titley OG, Chester DL, Park AJ (2004) A-a type, arterialized, venous, flow-through, free flap for simultaneous digital revascularization and soft tissue reconstruction-revisited. Ann Plast Surg 53(2):185–191

    Article  CAS  PubMed  Google Scholar 

  12. Koch H, Moshammer H, Spendel S, Pierer G, Scharnagl E (1999) Wrap-around arterialized venous flap for salvage of an avulsed finger. J Reconstr Microsurg 15(5):347–350

    Article  CAS  PubMed  Google Scholar 

  13. Inoue G, Tamura Y (1991) One-stage repair of both skin and tendon digital defects using the arterialized venous flap with palmaris longus tendon. J Reconstr Microsurg 7(4):339–343

    Article  CAS  PubMed  Google Scholar 

  14. Chen CL, Chiu HY, Lee JW, Yang JT (1994) Arterialized tendocutaneous venous flap for dorsal finger reconstruction. Microsurgery 15(12):886–890

    Article  CAS  PubMed  Google Scholar 

  15. Inoue G, Tamura Y, Suzuki K (1996) One-stage repair of skin and tendon digital defects using the arterialized venous flap with palmaris longus tendon: an additional four cases. J Reconstr Microsurg 12(2):93–97

    Article  CAS  PubMed  Google Scholar 

  16. Cho BC, Byun JS, Baik BS (1999) Dorsalis pedis tendocutaneous delayed arterialized venous flap in hand reconstruction. Plast Reconstr Surg 104(7):2138–2144

    Article  CAS  PubMed  Google Scholar 

  17. Nakayama Y, Soeda S, Kasai Y (1981) Flaps nourished by arterial inflow through the venous system: an experimental investigation. Plast Reconstr Surg 67:328–334

    Article  CAS  PubMed  Google Scholar 

  18. Chavoin JP, Rouge D, Vachaud M, Boccalon H, Costagliola M (1987) Island flaps with an exclusively venous pedicle. A report of eleven cases and a preliminary haemodynamic study. Br J Plast Surg 40:149–154

    Article  CAS  PubMed  Google Scholar 

  19. Baek SM, Weinberg H, Song Y, Park CG, Biller HE (1985) Experimental studies in the survival of venous island flaps without arterial inflow. Plast Reconstr Surg 75:88–95

    Article  CAS  PubMed  Google Scholar 

  20. Matsushita K, Firrel JC, Ogden L, Tsai TM (1993) Blood flow and tissue survival in the rabbit venous flap. Plast Reconstr Surg 91:127–135

    Article  CAS  PubMed  Google Scholar 

  21. Cho BC, Lee MS, Lee JH, Byun JS, Baik BS (1998) The effects of surgical and chemical delay procedures on the survival of arterialized venous flaps in rabbits. Plast Reconstr Surg 102(4):1134–1143

    Article  CAS  PubMed  Google Scholar 

  22. Yoshimura M, Shimada T, Imura S, Shimamura K, Yamauchi S (1987) The venous skin graft method for repairing skin defects of the fingers. Plast Reconstr Surg 79(2):243–250

    Article  CAS  PubMed  Google Scholar 

  23. Inoue G, Maeda N (1988) Arterialized venous flap coverage for skin defects of the hand or foot. J Reconstr Microsurg 4(4):259–266

    Article  CAS  PubMed  Google Scholar 

  24. Inoue G, Maeda N, Suzuki K (1990) Resurfacing of skin defects of the hand using the arterialised venous flap. Br J Plast Surg 43(2):135–139

    Article  CAS  PubMed  Google Scholar 

  25. Nishi G (1994) Venous flaps for covering skin defects of the hand. J Reconstr Microsurg 10(5):313–319

    Article  CAS  PubMed  Google Scholar 

  26. Kong BS, Kim YJ, Suh YS, Jawa A, Nazzal A, Lee SG (2008) Finger soft tissue reconstruction using arterialized venous free flaps having 2 parallel veins. J Hand Surg Am 33(10):1802–1806

    Article  PubMed  Google Scholar 

  27. Inoue G, Maeda N, Suzuki K (1991) Closure of big toe defects after wrap-around flap transfer using the arterialized venous flap. J Reconstr Microsurg 7(1):1–8

    Article  CAS  PubMed  Google Scholar 

  28. Chen HC, Tang YB, Noordhoff MS (1991) Four types of venous flaps for wound coverage: a clinical appraisal. J Trauma 31(9):1286–1293

    Article  CAS  PubMed  Google Scholar 

  29. Fukui A, Inada Y, Maeda M, Mizumoto S, Yajima H, Tamai S (1994) Venous flap––its classification and clinical applications. Microsurgery 15(8):571–578

    Article  CAS  PubMed  Google Scholar 

  30. Thatte MR, Thatte RL (1993) Venous flaps. Plast Reconstr Surg 91(4):747–751

    Article  CAS  PubMed  Google Scholar 

  31. Woo SH, Kim KC, Lee GJ, Ha SH, Kim KH, Dhawan V, Lee KS (2007) A retrospective analysis of 154 arterialized venous flaps for hand reconstruction: an 11-year experience. Plast Reconstr Surg 119(6):1823–1838

    Article  CAS  PubMed  Google Scholar 

  32. Foucher G, Norris RW (1988) The venous dorsal digital island flap or the “neutral” flap. Br J Plast Surg 41(4):337–343

    Article  CAS  PubMed  Google Scholar 

  33. Fukui A, Inada Y, Maeda M, Tamai S, Mizumoto S, Yajima H, Sempuku T (1989) Pedicled and “flow-through” venous flaps: clinical applications. J Reconstr Microsurg 5(3):235–243

    Article  CAS  PubMed  Google Scholar 

  34. Fukui A, Maeda M, Tamai S, Inada Y (1993) The pedicled venous flap. Clinical applications. Br J Plast Surg 46(1):68–71

    Article  CAS  PubMed  Google Scholar 

  35. Xiu ZF, Chen ZJ (1995) Clinical applications of venous flaps. Ann Plast Surg 34(5):518–522

    Article  CAS  PubMed  Google Scholar 

  36. Cil Y, Yapici AK, Kocman AE, Ozturk S (2009) Distally based venous flap for proximal phalangeal soft tissue burn defect and web space burn contracture. J Burn Care Res 30(4):643–647

    Article  PubMed  Google Scholar 

  37. Amarante J, Costa H, Reis J, Soares R (1988) Venous skin flaps: an experimental study and report of two clinical distal island flaps. Br J Plast Surg 41(2):132–137

    Article  CAS  PubMed  Google Scholar 

  38. Inada Y, Fukui A, Tamai S, Kakihana T, Maeda M (1991) The sliding venous flap for covering skin defects with poor blood supply on the lateral aspects of fingers. Br J Plast Surg 44(5):368–371

    Article  CAS  PubMed  Google Scholar 

  39. Tsai TM, Matiko JD, Breidenbach W, Kutz JE (1987) Venous flaps in digital revascularization and replantation. J Reconstr Microsurg 3(2):113–119

    Article  CAS  PubMed  Google Scholar 

  40. Kantarci U, Cepel S, Gürbüz C (1998) Venous free flaps for reconstruction of skin defects of the hand. Microsurgery 18(3):166–169

    Article  CAS  PubMed  Google Scholar 

  41. Inada Y, Hirai T, Fukui A, Omokawa S, Mii Y, Tamai S (1992) An experimental study of the flow-through venous flap: investigation of the width and area of survival with one flow-through vein preserved. J Reconstr Microsurg 8(4):297–302

    Article  CAS  PubMed  Google Scholar 

  42. Brooks D, Buntic R, Buncke HJ (2002) Use of a venous flap from an amputated part for salvage of an upper extremity injury. Ann Plast Surg 48(2):189–192

    Article  PubMed  Google Scholar 

  43. Yilmaz M, Menderes A, Karataş O, Karaca C, Barutçu A (1996) Free arterialised venous forearm flaps for limb reconstruction. Br J Plast Surg 49(6):396–400

    Article  CAS  PubMed  Google Scholar 

  44. Woo SH, Jeong JH, Seul JH (1996) Resurfacing relatively large skin defects of the hand using arterialized venous flaps. J Hand Surg Br 21(2):222–229

    CAS  PubMed  Google Scholar 

  45. Nakazawa H, Nozaki M, Kikuchi Y, Honda T, Isago T (2004) Successful correction of severe contracture of the palm using arterialized venous flaps. J Reconstr Microsurg 20(7):527–531

    Article  PubMed  Google Scholar 

  46. Hýza P, Veselý J, Novák P, Stupka I, Sekác J, Choudry U (2008) Arterialized venous free flaps––a reconstructive alternative for large dorsal digital defects. Acta Chir Plast 50(2):43–50

    PubMed  Google Scholar 

  47. Inoue G, Suzuki K (1993) Arterialized venous flap for treating multiple skin defects of the hand. Plast Reconstr Surg 91(2):299–302 (discussion pp 303–306)

    Article  CAS  PubMed  Google Scholar 

  48. Hyza P, Vesely J, Stupka I, Cigna E, Monni N (2005) The bilobed arterialized venous free flap for simultaneous coverage of 2 separate defects of a digit. Ann Plast Surg 55(6):679–683

    Article  CAS  PubMed  Google Scholar 

  49. Trovato MJ, Brooks D, Buntic RF, Buncke GM (2008) Simultaneous coverage of two separate dorsal digital defects with a syndactylizing venous free flap. Microsurgery 28(4):248–251

    Article  PubMed  Google Scholar 

  50. Takeuchi M, Sakurai H, Sasaki K, Nozaki M (2000) Treatment of finger avulsion injuries with innervated arterialized venous flaps. Plast Reconstr Surg 106(4):881–885

    Article  CAS  PubMed  Google Scholar 

  51. Kayikçioğlu A, Akyürek M, Safak T, Ozkan O, Keçik A (1998) Arterialized venous dorsal digital island flap for fingertip reconstruction. Plast Reconstr Surg 102(7):2368–2372 (discussion pp 2373)

    Article  PubMed  Google Scholar 

  52. Kushima H, Iwasawa M, Maruyama Y (2002) Recovery of sensitivity in the hand after reconstruction with arterialised venous flaps. Scand J Plast Reconstr Surg Hand Surg 36(6):362–367

    Article  PubMed  Google Scholar 

  53. Chia J, Lim A, Peng YP (2001) Use of an arterialized venous flap for resurfacing a circumferential soft tissue defect of a digit. Microsurgery 21(8):374–378

    Article  CAS  PubMed  Google Scholar 

  54. Brooks D, Buntic RF, Taylor C (2008) Use of the venous flap for salvage of difficult ring avulsion injuries. Microsurgery 28(6):397–402

    Article  PubMed  Google Scholar 

  55. Iwasawa M, Ohtsuka Y, Kushima H, Kiyono M (1997) Arterialized venous flaps from the thenar and hypothenar regions for repairing finger pulp tissue losses. Plast Reconstr Surg 99(6):1765–1770

    Article  CAS  PubMed  Google Scholar 

  56. Koshima I, Itoh S, Takahashi Y, Nanba Y, Kishimoto K (2001) Free vascularized nail graft under digital block. J Reconstr Microsurg 17(8):599–601 (discussion pp 602)

    Article  CAS  PubMed  Google Scholar 

  57. Nakayama Y, Iino T, Uchida A, Kiyosawa T, Soeda S (1990) Vascularized free nail grafts nourished by arterial inflow from the venous system. Plast Reconstr Surg 85(2):239–245 (discussion pp 246–247)

    Article  CAS  PubMed  Google Scholar 

  58. Patradul A, Ngarmukos C, Parkpian V, Kitidumrongsook P (1999) Arterialized venous toenail flaps for treating nail loss in the fingers. J Hand Surg Br 24(5):519–524

    Article  CAS  PubMed  Google Scholar 

  59. Reynoso R, Haddad JL, Sastré N (2000) A few considerations regarding enhancement of arterialized skin flap survival. Microsurgery 20(4):176–180

    Article  CAS  PubMed  Google Scholar 

  60. Kakinoki R, Ikeguchi R, Nankaku M, Nakamua T (2008) Factors affecting the success of arterialised venous flaps in the hand. Injury 39(Suppl 4):18–24

    Article  PubMed  Google Scholar 

  61. Moshammer HE, Schwarzl FX, Haas FM, Maechler H, Pierer G, Wiltgen M, Koch H (2003) Retrograde arterialized venous flap: an experimental study. Microsurgery 23(2):130–134

    Article  PubMed  Google Scholar 

  62. Koch H, Scharnagl E, Schwarzl FX, Haas FM, Hubmer M, Moshammer HE (2004) Clinical application of the retrograde arterialized venous flap. Microsurgery 24(2):118–124

    Article  PubMed  Google Scholar 

  63. Byun JS, Constantinescu MA, Lee WP, May JW (1995) Effects of delay procedures on vasculature and survival of arterialized venous flaps: an experimental study in rabbits. Plast Reconstr Surg 96(7):1650–1659

    Article  CAS  PubMed  Google Scholar 

  64. Wungcharoen B, Pradidarcheep W, Santidhananon Y, Chongchet V (2001) Pre-arterialisation of the arterialised venous flap: an experimental study in the rat. Br J Plast Surg 54(7):621–630

    Article  CAS  PubMed  Google Scholar 

  65. Fukui A, Inada Y, Murata K, Ueda Y, Tamai S (1998) A method for prevention of arterialized venous flap necrosis. J Reconstr Microsurg 14(1):67–74

    Article  CAS  PubMed  Google Scholar 

  66. Mutaf M, Tasaki Y, Fujii T (1998) Expansion of venous flaps: an experimental study in rats. Br J Plast Surg 51(5):393–401

    CAS  PubMed  Google Scholar 

  67. Ueda Y, Mizumoto S, Hirai T, Doi Y, Fukui A, Tamai S (1997) Two-stage arterialized flow-through venous flap transfer for third-degree burn defects on the dorsum of the hand. J Reconstr Microsurg 13(7):489–496

    Article  CAS  PubMed  Google Scholar 

  68. De Lorenzi F, van der Hulst RR, den Dunnen WF, Vranckx JJ, Vandenhof B, Francois C, Boeckx WD (2002) Arterialized venous free flaps for soft-tissue reconstruction of digits: a 40-case series. J Reconstr Microsurg 18(7):569–574 (discussion pp 575–577)

    Article  PubMed  Google Scholar 

  69. Karacalar A, Ozcan M (1994) Free arterialized venous flap for the reconstruction of defects of the hand: new modifications. J Reconstr Microsurg 10(4):243–248

    Article  CAS  PubMed  Google Scholar 

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Yan, H., Zhang, F., Akdemir, O. et al. Clinical applications of venous flaps in the reconstruction of hands and fingers. Arch Orthop Trauma Surg 131, 65–74 (2011). https://doi.org/10.1007/s00402-010-1107-2

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