Use of the venous flap for salvage of difficult ring avulsion injuries

Abstract

Ring avulsion can lead to soft tissue compromise resulting in eventual digit failure or restriction of motion. The authors present use of the venous flow through flap for simultaneous soft tissue and digital vessel reconstruction in severe ring avulsion injury. A retrospective review of ring avulsion injuries treated with transplantation of an arterialized (A-V-A) venous flap between 1999 and 2006 was conducted. Indications included digits which were debrided and required soft tissue and digital artery reconstruction. Eight venous flaps were transplanted for 3 Urbaniak class II and 5 Urbaniak class III ring avulsions. Average size of the venous flap was 6 cm(2). All flaps and digits survived without partial necrosis. The soft tissue envelope was supple in all cases. Total active motion (TAM) ranged from 160 to 210 degrees. The arterialized venous flow-through flap is a reliable solution for the complex ring avulsion injury which requires simultaneous soft tissue and digital vessel reconstruction.

Arterialized venous flaps: A review of the literature

“…This flap was applied to salvage the avulsed palmar tissue with good results. 39 We used an AVF to reconstruct a ring avlusion injury with success, 47 and salvage of other degloved fingers with this flap was also reported. 13,33,36 Besides, it can serve as composite flaps not only for the coverage of skin defects but also for the reconstruction of tendon and nerve defects.…”

Artery–Vein–Artery Venous Flap for Simultaneous Soft-Tissue Repair and Radial Artery Reconstruction: Case Report

“…7 The largest of the previously reported AVA flaps was 3.0 ϫ 4.5 cm. 4,5,7,8 Our case illustrates that a similar approach to simultaneous reconstruction can be accomplished on a larger scale at the wrist using an AVA flap.…”

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

“…1,18,36 They also tended to have best circulation on postoperative observation and are considered to be more reliable than venous flaps. 4,6,11,19,37 However, arterialized venous flaps tended to become congested and oedematous for up to 6 weeks postoperation in as many as 40% of cases. 25 Flap survival is likely dependent on changes and adaptation within the microcirculation.…”

“…6,9 The clinical applications of these flaps have similarly expanded. Since 1990s, venous flaps have been used for other reconstruction of the upper limb, especially the finger and dorsum of the hand, 4,6,[10][11][12][13][14] and lower limb. [15][16][17] The particular benefits of venous flaps comprise situations where arterial donor site morbidity is undesirable or in areas where large healthy veins could be found proximal and distal to the wound.…”