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.
