Venous Anastomosis for Prevention of Venous Congestion in Distally Based Flaps

Abstract

Background:Distally based flaps are useful for the treatment of skin defects of the extremities. However, congestion in the peripheral part of the flap due to reverse flow can cause partial flap necrosis. Previously, we reported on the effectiveness of venous anastomoses to rescue peripheral congestion of distally based flaps and applied this idea in a clinical setting. In this report, we present clinical cases of distally based flaps with venous supercharge anastomoses for changing the reverse venous flow into physiological flow, thereby reducing venous congestion.Methods:Four patients with skin defects of the extremities (2 cases with defects of the knee and the upper third of the lower leg, 1 case of the lower third of the lower leg, and 1 case of the distal third of the forearm) were treated with local flaps (2 cases with distally based greater saphenous venoadipofascial sartorius muscle combined flaps, 1 case with a distally based lesser saphenous venoadipofascial flap, and 1 case with a distally based ulnar artery perforator flap). In each reconstruction, 1 or 2 veins in the flaps were anastomosed with superficial veins in the recipient area to change the reverse venous flow into a normal, physiologic flow.Result:All flaps healed completely without any obvious venous congestion or flap necrosis. The coverage quality provided by these defects was satisfactory.Conclusions:Adding venous anastomoses may reduce the risk of venous congestion and improve the outcomes of the distally based flaps.

Resurfacing complex knee and upper third leg defect with reverse vastus lateralis muscle flap in a flap exhausted leg - A case report

“…Doppler signals intra operative were helpful in our case as there are multiple distal perforator supplying the muscle and a more distal perforators may be chosen; however, this comes with a rider, that the most proximal working area of muscle may necrose. 3,7 Donor site closure primarily has been quoted in literature, 7 but we feel that it becomes too tight closure and may lead to compartment.…”

“…2 Reverse flaps from thigh will come to rescue when there are no options left, knowing the nature and blood supply of these reverse flow muscle flaps will help salvage the knee joint in more than one ways. 3 This case report has been written with an intention to describe our surgical intricacies, ordeal faced, course of flaps in the course of reconstruction to resurface such a defect involving knee, upper third leg almost extending to the junction of middle one third leg, within a flap exhausted leg seen till the end of treatment.…”

Soft Tissue Coverage for Defects around the Knee Joint

“…A prior delay by ligating the proximal end of the feeding artery or supercharging and venous augmentation can ensure good survival of the flap. 22 23…”