Venous flow-through flaps (venous flaps) are useful reconstructive options, particularly in the repair of defects with segmental vessel loss. They are relatively easy to harvest and confer several benefits at the donor site. However, given that they are based on a single central vein, their survival is notoriously unreliable and they are susceptible to ischemia and venous congestion. Various designs have been suggested to improve the circulatory physiology, and hence survival, of venous flap. More recent designs involve adaptations to the arrangement and number of efferent veins draining arterialized venous flaps. The most commonly used classification system for venous flaps, proposed by Chen, Tang, and Noordhoff, does not afford adequate description of these alternate designs. This article offers a classification system that can incorporate all reported modifications to venous flaps. This simple adaptation to the classification system proposed by Chen et al. restores its usefulness in describing modern variations to venous flap design.

Large scalp defects can require complicated options for reconstruction, often only achieved with free flaps. In some cases, even a single free flap may not suffice. We review the literature for options in the coverage of all reported large scalp defects, and report a unique case in which total scalp reconstruction was required. In this case, two anterolateral thigh (ALT) flaps were used to resurface a large scalp and defect, covering a total of 743 cm(2). The defect occurred after resection and radiotherapy for desmoplastic melanoma, with several failed skin grafts and local flaps and osteoradionecrosis involving both inner and outer tables of the skull. The reconstruction was achieved as a single-stage reconstruction and involved wide resection of cranium and overlying soft-tissues and reconstruction with calcium phosphate bone graft substitute, titanium mesh, and two large ALT flaps. The reconstruction was successfully achieved, with minor postoperative complications including tip necrosis of one of the flaps and wound breakdown at one of the donor sites. This is the first reported case of two large ALT flaps for scalp resurfacing and may be the largest reported scalp defect to be completely resurfaced by free flaps. The use of bilateral ALT flaps can be a viable option for the reconstruction of large and/or complicated scalp defects.

The success of these techniques offers the potential to re-establish flow to large segmental losses to axial arteries, offer safe and definitive flap coverage to traumatic wounds, improve the array of flap options in this setting, and minimize donor site morbidity.

Specific thromboprophylaxis remains under-utilized in patients undergoing surgery for hip fracture at Royal Perth Hospital. These data should prompt the implementation of effective strategies to improve thromboprophylaxis practice patterns in high-risk orthopaedic patients.

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Perioperative blood loss during and following breast reconstruction surgery can have substantial impact on free flap survival and patient morbidity. Transfusion rates of up to 95% have been reported following transverse rectus abdominis myocutaneous flap breast reconstruction, with blood loss described as significant in most cases. However, there has been little reported of such requirements in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. We present the transfusion requirements of 152 consecutive patients who underwent DIEP flap breast reconstruction, with a view to quantifying transfusion requirements and identifying risk factors for such loss. In this cohort, 80.3% of patients required blood transfusion, with a mean volume of 3.9 U per patient. There was a statistically significant correlation for increased transfusion requirement in patients with preoperative anemia ( P < 0.001) and in bilateral cases ( P < 0.001), but not for cases of immediate reconstruction ( P = 0.72). Although blood loss in breast reconstructive surgery is rarely large enough to be life-threatening, relative anemia does have significant effect on flap survival and patient morbidity. With risk factors for increased transfusion requirements identified in the current study, high-risk patients can be predicted preoperatively.

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