Use of vein loops in reconstructive procedures

Abstract

The use of a temporary arteriovenous fistula prior to flap harvesting was suggested by Threlfall in 1982 (Threlfall, Aust NZ J Surg 52:182-184, 1982). The basic idea is to use long venous grafts that can be branched side-to-end to a main artery at an easily accessible level using one of the well-established exposures from general vascular surgery. In reconstructive microsurgery, AV-loops are used in limb salvage procedures and in cancer surgery. These patients have often undergone previous surgery and additional radiotherapy. AV-loops facilitate the use of normal recipient vessels out of the zone of injury, or far away from scar or irradiated tissue.

Bone Reconstruction of the Lower Extremity: Complications and Outcomes

“…1 through 5). [13][14][15][16] Although arteriovenous fistula formation and free flap transfer could be performed in one stage, we usually transfer the flap after adequate flow in the fistula has been established. This procedure was used in the last five cases of microsurgical reconstruction in this series.…”

“…1 Many procedures have been described to achieve bone reconstruction, including conventional and vascularized bone grafts 2-7 and the Ilizarov intercalary bone transport method, 8 -11 combined with local or free flaps for soft-tissue coverage. Also, procedures such as delayed inset of flaps 12 and the use of arteriovenous fistulas [13][14][15][16] help prevent complications related to poor vascular recipient sites. Many lower extremities are thus salvaged.…”

Utility of arteriovenous loops before free tissue transfer for post-traumatic leg defects

“…He suggested the use of long vein grafts anastomosed end to side to a main vessel at an accessible level, proximal to the trauma zone. The use of AV loops have subsequently been extended to trauma, cancer surgery[ 9 ] as well as limb salvage procedures in diabetic foot. [ 10 ] The femoral vessels in the sub sartorial canal are recognised as ideal recipient vessels due to large calibre, accessibility, and ease of positioning, larger pressure head and lesser chances of jeopardising distal limb vascularity especially if a large branch or tributary is used for anastomosis instead of the main vessel.…”

Flap Coverage of Anterior Abdominal Wall Defects

“…Specifically, arteriovenous flaps can be brought off of the femoral vessels using a saphenous vein graft. 11 Commonly utilized free flaps for reconstruction of this region include the ALT and the tensor fasciae lata flaps. These flaps are based upon the lateral circumflex femoral system.…”