Optimizing the Arterialized Venous Flap

Abstract

Survival of arterialized venous flaps is optimized by using smaller-caliber veins for inflow and reserving larger-caliber veins for outflow. This regulates inflow and avoids high blood pressure, and arterialized venous flaps behave as physiologic flaps do, by not relying on neovascularization for survival.

The arterialized saphenous venous flow‐through flap with dual venous drainage

“…6 They are also prone to thrombosis, apparently due to less oxygenated blood that flow at a slow sluggish rate through the flap. 32,33 These flaps also tend to become fibrotic, inelastic, with a propensity to adhere to underlying structure. Partial and total flap failures appear to be less pronounced with smaller flaps, 6 and hence, pure venous flaps are often recommended for small flaps only and predominantly in hand reconstruction.…”

“…Techniques used to reduce high blood pressure in the venous system include small afferent and large efferent vein, 42,43 and chemical or surgical delay of the flap. 1,32 The latter method not only improve flap survival but also allow for larger flaps to be used. 1 Cho et el.…”

“…32,50 However, when several veins are used, the survival and dimensions of viable venous flaps are increased when several veins were anastomosed. 35,37,20,32 Methods to aid venous drainage have included the utilization of a broader venous plexus in flap design, and to not use the central vein for both afferent and efferent limbs, as described by Lin et al In an attempt to improve the venous drainage of arterialized venous flaps, Lin et al 25 described five drainage patterns incorporated into flap design to aid venous drainage. Each of these methods, however, either limited the capability of the flap to act as an arterial conduit or threatened the intrinsic vascular anatomy of the flap.…”

“…32 An AV fistula often forms at the proximal anastomosis between the artery and the afferent vein. These AV fistulae may clot off and become redundant as the circulation becomes established at the skin edges.…”

The position of ‘shunt restriction’ along an arterialized vein affects venous congestion and flap perfusion of an arterialized venous flap

“…Venous congestion may resolve in 7e14 days through neovascularization during the wound healing phase. 4,5 However, the fibrotic change that follows secondary healing in partial flap loss is undesirable in a flap that is applied to the hand and fingers.…”