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Objective:To explore the surgical method and clinical effect of forearm arterialized venous flap in repair of soft tissue defects of fingers.Methods:A total of 13 cases of finger soft tissue defects with exposure of deep tissue were repaired with forearm arterialized venous flap from January, 2013 to October, 2019. The flap was designed in the forearm, and 2 parallel superficial veins were selected, the diameter of vein was similar to that at recipient site. The long axis of the flap was the same as that of the vein, and the width of the flap was divided into 3 equal parts by the 2 superficial veins. The free flap was cut longitudinally in the middle between 2 vessels under microscope, and a width of about 2 mm of the subcutaneous tissue was removed to the subdermal vascular network. The communicating branch between 2 vessels was ligated, and the subcutaneous tissue between 2 vessels was cut completely. The flap was not inverted, and the cut area was 3.5 cm× 2.5 cm-7.0 cm×4.0 cm. The proximal ends of the 2 vessels in the flap were anastomosed with the arteries and veins of the recipient area.Results:Thirteen flaps survived, and 9 patient entered follow-up for an average of 11(3-23) months. The flaps were soft and had no effect on the joint movement, slightly bloated. The TPD of flaps was 9 - 18 mm, with an average of 13 mm.Conclusion:Forearm arterialized venous flap has the advantages of high survival rate, satisfactory function, finger pulp-type change, superficial location, easy harvest and no sacrifice of main artery. It is an ideal method for repairing finger soft tissue defects.
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Objective:To investigate the effect of free basilic vein flap with sensory nerve in repair of digit pulp defect.Methods:From August, 2017 to December, 2020, 26 thumb and finger pulp defects were repaired with free basilic vein flap with sensory nerve. There were 23 defects of digit pulp, and 3 combined with dorsal soft tissue defect. The sizes of defect area of 11 thumbs and 15 fingers were 3.0 cm×2.0 cm-5.0 cm×3.5 cm. The size of flap was 3.5 cm×2.5 cm-5.5 cm×4.5 cm. All of the digit defects were repaired with free basilic vein flap carrying sensory nerve at the medial side of proximal forearm. All donor sites at forearm were directly sutured. All patients entered follow-up by clinic visit by telephone appointment. The appearance of the flaps was good with satisfactory texture, good pinching and well recovered sensation.Results:All 26 flaps survived in the 3-28 months(13 months in average) of follow-up. The TPD was 6-8 mm (6.8 mm in average). Only linear scars left at the donor sites without obvious discomfort, except 3 cases having in minor bloating. The bloated flaps were repaired 3 months after the primary surgery, and achieved more satisfactory appearances.Conclusion:Free basilic vein flap with sensory nerve is an ideal method to repair defect of digit pulp, especially in the digit pulp composite tissue defect combined with vessel and nerve defect.
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Objective: To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers. Methods: Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft. Results: All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm). Conclusion: Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.
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Objective To investigate the clinical effect of super large venous flap with palmaris longus tendon for repairing the complex tissue defect of the palm of finger.Methods From May,2011 to October,2017,complex tissue defect of the palm of 15 fingers in 15 cases was treated by a super large vein flap with palmaris longus tendon.There were 10 males with 10 fingers and 5 females with 5 fingers.The age was from 19 years to 51 years (average,35.8years).Among these cases,machine injury was in 12 cases and crush injury was in 3 cases.Complex tissue defect of the palm of the finger with tendon defect occurred in all the cases.There were 3 thumbs,5 index fingers,3 middle fingers and 5 ring fingers.The area of skin defect was from 3.5 cm×2.0 cm to 7.5 cm×3.5 cm.The length of tendon defect was 2.0-4.0 cm.Phalangeal fractures occurred in 4 cases (2 cases of proximal phalanx,1 of middle phalanx,and 1 of distal phalanx).All the patients received the operation in one stage.The time between the injury and the operation was 1.5-3.0h(average,2.0 h).The time of the operation was 3.0-4.5 h(average,3.6 h).Regular followed-up was performed after operation.Results All flaps survived.Fourteen cases were followed-up for 6 to 12 months(average,7 months),and 1 case lost.The skin flap has soft texture,good elasticity,and no bloat.The color of skin flap was close to the normal skin.Sensory recovery reached S2 to S3,and the function and appearance of the finger were well restored.Conclusion The super large vein flap with palmaris longus tendon can be used to repair the complex tissue defect of the palm of fingers.The flap can get a satisfactory effect after surviving.It is an ideal method of repairing this kind of damage.
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Objective To explore the application and clinical effect of blood bridge venous flap in finger wound with proper palmar digital artery defect. Methods From February,2007 to September,2016,11 cases of fin-ger wound with artery defect were repaired with forearm vein free flap by the way of bridging blood vessels. The time from injury to surgery was 1.5 to 6 hours(average 2.5 hours).Vascular defect length was 1.4 to 3.4 cm(average 2.3 cm). 8 cases were bridged the unilateral digital artery and 3 cases were bridged the both side. The area of skin flap was 1.5 cm × 2.0 cm to 2.2 cm × 3.5 cm and the donor site was sutured directly. Results One case appeared necrosis in marginal part and healed after dressing change. The other flaps and finger survived and the incisions healed well.All the 11 cases were followed up after operation. The follow-up time ranged from 6 to 20 months, aver-aged 10 months. The color and texture were well,the sensation of temperature, pain and tactile were recovered, and the flap had good contour. According to TAM system evaluation method: 6 cases got excellent results,4 cases were good,1 case was poor. The donor site only had a linear scar and the flexion and extension of wrist were not limited. Conclusion Flow bridging venous flap can reconstruct the finger blood and repair the wound simultaneously. To the finger with nerve or tendon defect,bridged with the cutaneous nerve or palmaris longus tendon can also get satisfactory result.
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Objective To explore a one-time repairing method for defects in palmar skin soft tissue, proper palmar nerves and arteries, and flexor tendon.Methods From March 2011 to June 2016, the defects in palamar skin, nerves, blood vessels or flexor tendons of 21 fingers in 20 cases were repaired by using the resected superficial veins and tendons and nerves of skin soft tissue on axes of indicis proprius tendon (extensor digiti quinti) or forearm-palmaris longus tendon or foot back short tendons of the first or second toes were cut according to the defects in palmar skin soft tissue, nerves, blood vessels and flexor tendon, Results All the vein flaps of the 20 cases were survived.The patients were followed up for 6 to 24 months.Both the shape and function of the fingers recovered well.The flaps were of good quality, with no obvious pigmentation, and good at sensations (The sensation between two points were 9 mm on average).Conclusion It was a simpler and more convenient way to repair defects in palmar skin soft tissue, nerves, blood vessels and flexor tendons using free venous flap with tendons and nerves for transplantation.It also ensures the blood-supply without sacrificing the main vessels, and thus it is an ideal method for repairing simultaneous defects in skin soft tissue, nerves and flexor tendon.
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Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.
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PURPOSE: The venous flap is used as an alternative method to the standard free flap for the management of small and thin soft tissue defects. Especially, the venous flap has advantages of being thin, easy harvest and various donor sites, as well as it having lower morbidity. Yet their clinical applications have been limited by their unstable postoperative course and also by their complications such as partial necrosis. The aim of this study is to extend the clinical indications of venous flaps with using various methods. METHODS: From May 2005 to March 2006, total of 19 patients(21 cases) underwent various venous flaps for soft tissue defects as a result of trauma(15 cases), facial skin cancer(3 cases), chronic ulcer(1 case) and surgical wound for congenital anomaly(2 cases). The arterialized venous free flap were applied in 18 cases, the pure venous free flap was applied in 1 case and the pure venous pedicled flap were applied in 2 cases. Among them, two flow-through arterialized venous free flaps were applied that used the great saphenous vein to reconstructed major arteries as well as the injured skin and soft tissues in the arm. All the flap were harvested from the volar wrist(11 cases), dorsum of foot(5 cases), thenar(2 cases), and medial thigh(3 cases). RESULTS: The sizes of the flap ranged from 0.75cm2 to 264cm2(mean size: 40.06cm2). The follow-up period ranged from two to twelve months. In the majority of cases, we obtained satisfying results, which was the excellent reconstruction of skin and soft tissue defects and especially in the case of limb salvage, replantation and cancer reconstruction. However, there were 5 cases of partial necrosis and 2 cases of complete failure. The donor sites were closed primarily in 7 cases and wound closure with skin graft were in 14 cases. CONCLUSION: We conclude that the venous flap will not only be useful for reconstruction of small defect in the hand and foot, but also be useful for various other clinical indications.
Subject(s)
Humans , Arm , Arteries , Follow-Up Studies , Foot , Free Tissue Flaps , Hand , Limb Salvage , Necrosis , Replantation , Saphenous Vein , Skin , Surgical Flaps , Tissue Donors , Transplants , Wounds and InjuriesABSTRACT
PURPOSE: The venous flap is used as an alternative method to the standard free flap for the management of small and thin soft tissue defects. Especially, the venous flap has advantages of being thin, easy harvest and various donor sites, as well as it having lower morbidity. Yet their clinical applications have been limited by their unstable postoperative course and also by their complications such as partial necrosis. The aim of this study is to extend the clinical indications of venous flaps with using various methods. METHODS: From May 2005 to March 2006, total of 19 patients(21 cases) underwent various venous flaps for soft tissue defects as a result of trauma(15 cases), facial skin cancer(3 cases), chronic ulcer(1 case) and surgical wound for congenital anomaly(2 cases). The arterialized venous free flap were applied in 18 cases, the pure venous free flap was applied in 1 case and the pure venous pedicled flap were applied in 2 cases. Among them, two flow-through arterialized venous free flaps were applied that used the great saphenous vein to reconstructed major arteries as well as the injured skin and soft tissues in the arm. All the flap were harvested from the volar wrist(11 cases), dorsum of foot(5 cases), thenar(2 cases), and medial thigh(3 cases). RESULTS: The sizes of the flap ranged from 0.75cm2 to 264cm2(mean size: 40.06cm2). The follow-up period ranged from two to twelve months. In the majority of cases, we obtained satisfying results, which was the excellent reconstruction of skin and soft tissue defects and especially in the case of limb salvage, replantation and cancer reconstruction. However, there were 5 cases of partial necrosis and 2 cases of complete failure. The donor sites were closed primarily in 7 cases and wound closure with skin graft were in 14 cases. CONCLUSION: We conclude that the venous flap will not only be useful for reconstruction of small defect in the hand and foot, but also be useful for various other clinical indications.
Subject(s)
Humans , Arm , Arteries , Follow-Up Studies , Foot , Free Tissue Flaps , Hand , Limb Salvage , Necrosis , Replantation , Saphenous Vein , Skin , Surgical Flaps , Tissue Donors , Transplants , Wounds and InjuriesABSTRACT
For the venous flap to survive, it apparently needs to be a flow-through of venous blood.1 Nevertheless, controversy remains, regarding the fact that an island flap based on a terminating venous pedicle is capable of maintaining viability.2-15 This study was designed to investigate the role of perivenous areolar tissue in the viability of island flaps with an exclusively venous pedicle in the rabbit ear model as described by Inada et al.16 Ten groups of flaps were studied: Group A-flaps based on a proximal venous pedicle; group B-flaps based on a distal venous pedicle; group C- nonvascularized grafts; each subgroup A1-, B1-flaps with perivenous areolar tissue; each subgroup A2-, B2-flap which was skeletonized pedicle; each subgroup A3-, B3-flap was same as A1-, B1-flap, which was sutured over a silastic sheet; each subgroup A4-, B4-flap with a skeletonized venous pedicle sutured over a silastic sheet; subgroup C1-control, placed directly on bed; subgroup C2-control which was sutured over a silastic sheet. Groups A3, A4, B3 and B4 had 20 flaps and the remaining groups had 10 flaps each. Flaps in group A1, A3, B3 had total survival. In groups A4, B4, C2, no flaps were survived. The survived flaps in groups A3 and B3 had tissue oxygen content values between those of arterial and venous levels. Histological examination of the pedicle of survived flaps in groups A3 and B3 showed small vascular channels present in the areolar tissue surrounding the venous pedicle. Static and dynamic computerized radioactive tracer experiments showed that the survived flaps in groups A3 and B3 were promptly perfused and drained through their pedicles. This study confirms the importance of the perivenous areolar tissue for survival of the venous skin flap in the rabbit ear model.
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Ear , Oxygen , Skeleton , Skin , Surgical Flaps , TransplantsABSTRACT
Scalp avulsion is rare injury that has serious consequences, including hospitalization, economic loss, devasting disfigurement, and psychological effects on the patient. Microvascular surgery now allows an initial chance for successful replantation and one-stage reconstruction. The need for secondary reconstructive procedures after a successful replantation is minimal. Our one year experience with 2 patients who suffered from avulsion of partial scalp is reviewed. Each patient got long hair entangled in the uncovered rotated machines and underwent replantation using microsurgical technique. Replantations have been accomplished using only arterio-venous and venous-venous anastomosis, without arterio-arterial anastomosis in 2 cases, because of unidentification of suitable arteries. The possible explanation for the success of the operation is the paucity of valves that exist in the venous network of the scalp and forehead. The final results were good. In the follow-up period, both experienced regrowth of hair in the scalp with light touch sensation.
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Humans , Arteries , Follow-Up Studies , Forehead , Hair , Hospitalization , Replantation , Scalp , SensationABSTRACT
Objective To investigate the microcirculative route of the arterialized venous flap.Methods Selecting 15 Chinese white rabbits designed the model of arterialized venous flap by anastomosis with from the central artery to central vein.The reversed blood flow perfusion was directly observed by the "ear windows" under the microscope and,simultaneous recording the changes in the microcirculation of the flap.Results All of the flaps were alived.The structure of the capillary net in the flap was a stereo-net .In the early arterialized stage,the upstream blood flows quickly in the venule;there was no blood flowing in the capillary net with the opening of the capillary net,the reconstructed procedure of the non-physilogical microcirculation was accomplished:the arterial blood mainly flow through small vein and venule,finally arrived the capillary net.Conclusions Keep up the drainage vein free,the arterialized venousflap could be alived by reconstructed effective microcirculation through the venous system.
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Despite the fact that arterialized venous flaps provide thin, good quality tissue to a defect of the face and neck, their clinical applications have been limited by unstable postoperative course and necrosis of the flap. The author tried to resolve these problems by applying tissue expansion techniques to the arterialized venous flap before flap transfer. Three cases of the pre-expanded arterialized venous free flap technique were used for postburn scar contracture of the cervicofacial region. The donor site was confined to the forearm. A rectangular expander was placed over the fascia of the flexor muscles on the proximal two thirds of the forearm. The mean expansion period, volume, and flap size were 44 days, 420 cc, and 147 cm2, respectively. There were no complications caused by expander insertion and expansion. One could successfully reconstruct the facial region after excision of postburn contractures with pre-expanded arterialized venous flaps without any marginal necrosis or unstable postoperative course of the flap. Thin and large arterialized venous flaps were well matched with the recipient defect on the cervicofacial area, since the color and texture match obtained with forearm tissue produced an aesthetically favorable result. Pre-expanded arterialized venous flaps are another new option for free flap reconstruction of the face and neck.
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Humans , Burns , Cicatrix , Contracture , Fascia , Forearm , Free Tissue Flaps , Muscles , Neck , Necrosis , Tissue Donors , Tissue ExpansionABSTRACT
In this experiment we investigated the reestablishment of microcirculation and perfusion ways in venous flaps by means of rabbit ear chambers, image processing system, and composing video picture techniques, within 7 days after the operation. The results showed that the microcirculation of venous flaps, within two days after operation, was reestablished by two kinds of perfusion ways: (1)Diversion of blood flow perfused the capillaries through the "to-and-fro" movement of venous blood. (2) The venous blood flowed into arterial vessels through arteriovenous anastomoses and perfused the capillaries. Later the second way replaced the first one within the 48 hours, since it could normally perfuse tissues and guarantee the venous flap blood supply for the rest of time.