J Reconstr Microsurg 1998; 14(6): 407-410
DOI: 10.1055/s-2007-1000200
ORIGINAL ARTICLE

© 1998 by Thieme Medical Publishers, Inc.

Free‐Flap Distal Arteriovenous Fistula: When to Close It?

J. Joris Hage, Stan Monstrey
  • Departments of Plastic and Reconstructive Surgery, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands, and Acad-emisch Ziekenhuis Gent, Belgium
Further Information

Publication History

Accepted for publication 1998

Publication Date:
08 March 2008 (online)

ABSTRACT

A distal arteriovenous fistula was created secondarily in an innervated radial forearm free flap, to salvage the neophallus in three female-to-male transsexuals. This resulted in permanent edema and an arterial thrill in the neophallus. The arteriovenous fistulas were closed after 6 weeks to 20 months. Acute endothelial damage with risk of thrombosis, due to ischemia and exposure to arterial blood pressure, may be expected to have been repaired 4 to 6 weeks after arterialization of the veins. Intimal thickening will have started by then, but a subsequent decrease in vascular luminal diameter may still be expected to be reversible. The authors conclude that ligation of the distal arteriovenous fistula may safely be performed some 6 weeks after the salvage procedure.