A few considerations regarding enhancement of arterialized skin flap survival

Reynoso, Rafael; Haddad, Jose Luis; Sastré, Nicolás

doi:10.1002/1098-2752(2000)20:4<176::aid-micr6>3.0.co;2-5

Cited by 16 publications

(13 citation statements)

References 14 publications

(8 reference statements)

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“…The results of the sensibility tests with Semmes-Weinstein monofilament (SWM) test revealed that most cases achieved satisfactory sensation recovery with diminished light touch (DLT) (filament level, 3.22Y3.61). The appearance was assessed as good (good color match, nonbulky, and pliable without contracture) in all the cases for the recipient site, whereas the case that reconstructed with conventional flap (DRFF) 18 was categorized as fair (slightly bulky) (Fig. 1A, B).…”

Section: Resultsmentioning

confidence: 99%

“…6 In our series, satisfactory results were achieved for flap survival, functional recovery, aesthetic outcomes as well as the number of secondary revision required. The main concern of AVFs is its survival status, which used to be considered as unreliable 18,30 ; however, with progressively technical modification, recent clinical practice has manifested that its survival rate can be comparable with that of the conventional flaps, especially when used for hand and finger reconstruction. 6,10 In this series, all the flaps survived completely.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

Yan¹,

Fan²,

Zhang³

et al. 2013

Annals of Plastic Surgery

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Coverage of the dorsal aspect of the fingers is difficult, especially when the defect is large and multiple digits are involved with composite tissue loss and very few conventional flaps are suitable in dealing with such situation. The purpose of this study was to present our experience of reconstruction of the large dorsal digital defects with the arterialized venous flap (AVF) and evaluate its merits and demerits in this clinical setting with a comprehensive review of literature. From August 2008 to December 2010, 7 composite palmaris longus venous flaps and 5 AVFs were used in the reconstruction of extensive dorsal digital injuries in 8 patients, and a comprehensive review of literature regarding the reconstruction of dorsal digital defects with AVFs was carried out. All the flaps survived completely. The outcomes were very satisfactory for functional recovery, aesthetic appearance, and sensation restoration at an average follow-up of 11.8 months; the literature review also revealed the similar results. On the basis of our experience and literature review, AVFs are reliable and good candidates for resurfacing large dorsal digital defects when local flaps are not available or insufficient for coverage. Composite AVF with palmaris longus tendon is an optimal choice for 1-stage reconstruction of dorsal composite finger injuries.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

Yan¹,

Fan²,

Zhang³

et al. 2013

Annals of Plastic Surgery

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“…In literature, several approaches have been attempted to solve the problem of venous congestion and improved the survival status of AVFs, such as using a relatively larger efferent vein and a relatively smaller afferent vein [15], adopting surgical or chemical delay tactics [16, 17], and anastomosing multiple draining veins [18]. Woo SH et al [18]proposed that more than two draining veins should be anastomosed for a better flap survival in the application of AVFs.…”

Section: Discussionmentioning

confidence: 99%

The complicated role of venous drainage on the survival of arterialized venous flaps

et al. 2017

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The arterialized venous flap (AVF) has been gradually popularized in clinical settings; however, its survival is still inconsistent and the role of venous drainage remains elusive. In this study, we aimed to investigate the role of venous drainage on the flap survival of arterialized venous flaps. An arterialized venous flap was outlined symmetrically in the rabbit abdomen. The arterial perfusion flap with a unilateral vascular pedicle was taken as the control group and three other experimental groups (I, II and III) were designed based on the number of drainage veins (n = 1, 2 and 3 in the three groups, respectively). Compared with the control group, significant venous congestion was noted in all the experimental groups and the most severe one was seen in group I; while no statistical difference was observed between groups II and III. Similar results regarding blood perfusion state, epidermal metabolite levels and flap survival status were obtained among the three groups. These findings suggested that venous drainage is vital in the survival of the flap, but unlike in the arterial perfusion flaps, the problem of venous congestion can only be partially solved by increasing the number of draining veins. Further studies are warranted to gain insight into this complicated issue.

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“…It is postulated that their poor survival is due to the low O 2 concentration of the afferent blood supply and venous congestion 3. 24…”

Section: Previous Classification Systemsmentioning

confidence: 99%

“…However, more recently, greater rates of survival and larger surviving flaps have been described, with a stronger emphasis in flap design on maximizing flap vascularity through oxygenated blood supply and improving venous drainage. Examples of novel means to achieve this include increasing the number of efferent veins draining the flap 24–27 and including additional efferent veins, which are discontiguous with the flap's central vein 5. 19 Recently, we reported a cohort of the largest venous flaps described, with dimensions reaching 8 cm × 20 cm, which all survived with a unique modification to flap design to augment venous drainage 5.…”

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confidence: 99%

The nomenclature of venous flow‐through flaps: Updated classification and review of the literature

et al. 2012

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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.

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A few considerations regarding enhancement of arterialized skin flap survival

Cited by 16 publications

References 14 publications

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

The complicated role of venous drainage on the survival of arterialized venous flaps

The nomenclature of venous flow‐through flaps: Updated classification and review of the literature

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