Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps

Abstract

Background Island pedicle flaps often have the problem of limited reach. In such cases, free flaps are useful for reconstruction but often have the issue of unavailability of suitable recipient vessels. Therefore, it would be helpful if the pedicle of an island flap could be extended as far as necessary.

Methods Here, we describe the use of interpositional vein grafts to extend island pedicle flaps for the reconstruction of an ischemic above-knee amputation stump in one case and to seal an intractable fistula on the buttock after radiation therapy in another case. In the patient with the ischemic stump, a deep inferior epigastric perforator flap was extended by 6 cm using the great saphenous vein harvested from the contralateral side, allowing successful coverage of the stump. In the patient with an intractable fistula on the buttock, a thoracodorsal artery and vein graft that was extended by 25 cm using the cephalic vein harvested from the right forearm to upper arm allowed successful sealing of the fistula.

Results Circulation was satisfactory in both cases and both flaps survived. The operative procedure was straightforward.

Conclusion Interpositional vein grafts may be a feasible option for the extension of island pedicle flaps to include the features of an island pedicle flap and a free flap.

Keywords

vein grafting - free flaps - island pedicle flaps

• References

• 1 Lin CH, Mardini S, Lin YT, Yeh JT, Wei FC, Chen HC. Sixty-five clinical cases of free tissue transfer using long arteriovenous fistulas or vein grafts. J Trauma 2004; 56 (05) 1107-1117
• 2 Hallock GG. The interposition arteriovenous loop revisited. J Reconstr Microsurg 1988; 4 (02) 155-159
• 3 Angel MF, Chang B, Clark N, Wong L, Ringelman P, Manson PN. Further clinical use of the interposition arteriovenous loop graft in free tissue transfers. Microsurgery 1993; 14 (08) 479-481
• 4 Bayramiçli M, Tetik C, Sönmez A, Gürünlüoğlu R, Baltaci F. Reliability of primary vein grafts in lower extremity free tissue transfers. Ann Plast Surg 2002; 48 (01) 21-29
• 5 Whitney TM, Buncke HJ, Lineaweaver WC, Alpert BS. Multiple microvascular transplants: a preliminary report of simultaneous versus sequential reconstruction. Ann Plast Surg 1989; 22 (05) 391-404
• 6 Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma 1989; 29 (08) 1086-1094
• 7 Miller MJ, Schusterman MA, Reece GP, Kroll SS. Interposition vein grafting in head and neck reconstructive microsurgery. J Reconstr Microsurg 1993; 9 (03) 245-251
• 8 Zhang F, Oliva A, Kao SD, Newlin L, Buncke HJ. Microvascular vein-graft patency in the rat model. J Reconstr Microsurg 1994; 10 (04) 223-227
• 9 Zhang F, Oliva A, Kao SD, Newlin L, Buncke HJ. Microvascular vein grafts in the rat cutaneous free-flap model. J Reconstr Microsurg 1994; 10 (04) 229-233
• 10 Cheng HT, Lin FY, Chang SC. Evidence-based analysis of vein graft interposition in head and neck free flap reconstruction. Plast Reconstr Surg 2012; 129 (05) 853e-854e
• 11 Furr MC, Cannady S, Wax MK. Interposition vein grafts in microvascular head and neck reconstruction. Laryngoscope 2011; 121 (04) 707-711
• 12 Nahai F, Hester TR, Jurkiewicz MJ. Microsurgical replantation of the scalp. J Trauma 1985; 25 (09) 897-902
• 13 Fudem GM, Marble KR. Latissimus dorsi free flap for sacral wound closure: the world's longest vein grafts for free tissue transfer. Microsurgery 1996; 17 (08) 449-451