Reconstruction of the Soft Tissue Defect of the Finger Using Digital Island Flap with Supercharged Vein

PURPOSE: The heterodigital or homodigital artery island flap is a popular method in reconstruction of finger defects. Sometimes, digital artery island flap has some disadvantages such as postoperative flap edema, congestion, and partial necrosis of the flap margin. However, we could decrease these disadvantages by means of venous superdrainage. The aim of this study is to report usefulness and postoperative results of venous supercharging digital artery island flaps for finger reconstruction. METHODS: From March 2005 to March 2008, a total of eight patients with soft tissue defects in the finger underwent venous supercharging digital island flap transfer. Briefly, the flap is harvested along with dorsal vein that is then anastomosed to the recipient vein in an end-to-end fashion, after flap transfer and insetting. Using this technique, eight patients were operated, whose ages ranged from 23 to 52 years. RESULTS: All the flaps survived with a success rate of 100 percent, thus fully satisfying the reconstructive requirements. No postoperative flap congestion was recognized, obviating the need to take any measures for venous engorgement, such as suture removal. Among 8 cases, it was possible to make an long-term and follow- up observation more than 6 months. In these cases, the fact that light touches and temperature sensations can be detected in all the flaps. Cold intolerance and hyperesthesia were not seen in our series. CONCLUSION: Providing good harmony with conventional methods and microsurgery, inclusion of a vein with the heterodigital and homodigital artery island flap allows a more reliable and safer reconstructive choice for finger defects. The venous supercharged island flap is a reliable flap with a consistent arterial structure, and with its augmented venous drainage, it is more reliable, providing single-stage reconstruction of adjacent finger defects, including the fingertip.

Reconstruction of the Soft Tissue Defect of the Lower Leg by Distally Based Superficial Sural Artery Fasciocutaneous Island Flap Using Supercharged Vein

PURPOSE: Distally based superficial sural artery island flap has some disadvantages such as postoperative flap edema, congestion, and partial necrosis of the flap margin. Venous congestion is an area of considerable concern in distally based superficial sural artery fasciocutaneous flap and is one of the main reasons for failure, particularly when a large flap is needed. However, we could decrease these disadvantages by means of venous superdrainage. METHODS: From June of 2006 to June of 2007, a total of two patients with soft tissue defects of lower one third of the leg underwent venous supercharging distally based superficial sural artery island flap transfer. The distal pivot point of this flap was designed at septocutaneous perforator from the peroneal artery of the posterolateral septum, which was 5cm above the tip of the lateral malleolus. Briefly, this technique is performed by anastomosing the proximal end of the lesser saphenous vein and collateral vein to any vein in the area of the recipient defect site. RESULTS: No venous congestion was noted in any of the two cases. No other recipient or donor-site complications were observed, except for minor wound dehiscence in one case. In 3 to 6 months follow-up, patients had minor complaints about lack of sensation in the lateral dorsal foot. CONCLUSION: The peroneal artery perforator is predictable and reliable for the design of a distally based superficial sural artery island flap. Elevation of the venous supercharging flap is safe, easy, and less time consuming. In conclusion, the venous supercharging distally based superficial sural artery island flap offers an alterative to free tissue transfer for reconstruction of the lower extremity.