An Experimental Study of the Venous Flap: Investigation of the Recipient Vein

Abstract

In previous studies using rabbit ears, total venous perfusion flaps (TVPF) were used that did not contain in the experimental model any chosen arteries truly representative of clinical venous flaps. We discovered that the TVPF could survive even under conditions of poor blood circulation. In the present study, conditions of the recipient veins were investigated using flow-through veins in TVPFs of rabbit ears and human dorsal digital veins. The research suggested that conditions for TVPF survival are a high density of the venous network in the flap and the presence of venous oscillation, high oxygen tension, and effective blood flow in the recipient vein. 123

An Experimental Study of the Flow-Through Venous Flap: Investigation of the Width and Area of Survival with One Flow-Through Vein Preserved

“…Although our experimental models were different from Baek's, we reported that the veins of flow-through venous flaps in the rabbit ear had 2.2 ± 0.42 mmHg venous pressure and clinically, veins from the dorsum of the finger to the dorsum of the hand, (which was selected as the recipient site) had venous pressures two to three times higher than rabbit-ear veins (venous pressure of the dorsum of the finger-, afferent venous pressure 5.9 ± 2.4 mmHg; efferent venous pressure 2.9 ± 1.0 mmHg). 3 From this, we deduce that a dense venous network alone will allow a flow-through venous flap, more than 1.10 ± 0.48 cm in width (the value validated experimentally) to survive in clinical cases. In any case, it is significant that the survival width and area of the flowthrough venous flap has been measured quantitatively.…”

“…It is also necessary that the ear vein, when acting as a pedicle, should have arterial rather than venous characteristics, i.e., good venous pressure and high venous oxygen tension. 3 However, it has also been reported that the measurement of blood flow in the flowthrough venous flap is not possible just after surgery, 4 and no studies have been done on what size flap can survive with only one flow-through vein. Spindly and thin flaps have been raised on a single venous pedicle in many clinical cases, while different survival rates have been reported.…”

Arterialized Venous Flow-Through Flap for Simultaneous Reconstruction of a Radial Artery Defect and Palmar Forearm Soft-Tissue Loss from Sarcoma Resection

“…the most common complication and a leading cause of venous flap failures. [12][13][14][15][16][17] Four types of venous flaps have been described, based on whether the inflow and outflow vessels are arterial or venous: veno-venous (v-v); arterio-venous (a-v), pedicle venous, and arterio-arterial (a-a). Many of the clinical experiences that have been reported have been with the veno-venous flaps (v-v) or the arteriovenous (a-v) venous flaps in soft-tissue reconstruction of the fingers, hands, extremities, and head and neck.…”

“…Arterialized venous flaps are thought to do better because of the higher level of oxygenation. 13,15,17 However, if known artery-based flaps are either not available or not suitable, venous flaps can be excellent options.…”

Circulating Mechanism of the “Pure” Venous Flap: Direct Observation of Microcirculation

“…In spite of the success of the pure venous flap, 3 " 16 ' 20 " 25 the mechanisms of its blood circulation has not been well understood. For example, it is not clear whether there is capillary perfusion immediately following transfer.…”