Upper Extremity Reconstruction/Revascularization Utilizing Venous Flaps after Traumatic Injury

Local procedures such as the cross-finger flap, island flap, and flag flap, among others, are well-described for the treatment of soft-tissue defects of the hand. Their effectiveness is, however, limited in cases of multi-digit injury, defects greater than 5 cm in length, and defects located on the radial side of the index, ulnar side of the small finger, and tip of the thumb. The bulkiness of conventional microvascular tissue transfer can limit its overall effectiveness. The authors presented their experience with the transfer of venous flaps for reconstruction of the thin, soft-tissue cover of the hand.

A retrospective study between June 2000 and February 2005 involved 50 venous flaps that were transferred for reconstruction of soft tissue defects of the hand. Indications for the venous flap included location, size, multi-digit injury, need for cover over vital structures, and need for digital revascularization/replantation. The flaps were classified as AVA, AVV, AVA/A, AVV/V, or VVV depending on their vascular anastomoses. Donor sites included saphenous vein (SAPH), cephalic vein (CEPH), volar proximal forearm (VPF), volar distal forearm (VDF), dorsal hand (DH), and dorsal finger (DF). Outcome was classified as successful, partial thickness (PT) survival, and partial full-thicknesss (PFT) survival. The flap was considered a failure if there was complete loss of the flap or significant loss that led to exposure of vital structures and need for an alternate procedure.

Forty flaps had 100% survival (80%), four flaps were considered PT (8%), three were considered PFT (6%), and two were considered failures (4%). There were often multiple indications for the venous flap in individual cases. Twenty-four flaps were classified as AVA, 14 AVV, 1 VVV, 3 AVA/A, 4 AVV/V, and 1 AVA/VVV. Eight flaps had multiple inflow and/or outflow anastomoses to nourish larger flaps, to reconstruct simultaneous arterial inflow and venous outflow in ring avulsion replants, or to provide cover and revascularization for multiple digits by creation of digital syndactyly. The donor was the VDF in 40 patients (80%), VPF in 5 patients (10%), SAPH in 2 patients (4%), DH in 1 (2%), and DF in 1 (2%). Size of the flaps ranged from 2 × 2 cm to 9 × 6 cm. The majority of flaps were 2 × 3 cm.

Venous flaps can provide reliable coverage for small and medium-sized soft tissue defects of the hand when conventional methods are less effective. Venous flaps have the additional benefit of reconstructing vascular inflow and/or outflow to amputated and devitalized components.