Arteriovenous fistula and skin flaps

An experimental study was done in a rat groin flap model to assess the possible effects of arteriovenous fistulas (AVF) on the viability of skin flaps. The animals were randomly divided into three groups. In Group 1, an island flap, and in Groups 2 and 3, peninsular flaps, including the superficial epigastric artery and vein, were elevated. In Group 2, the base of the peninsula was on the rectus side of the flap; in Group 3, the base of the peninsula was located on the lower extremity side. After elevation of the flap and following arteriovenotomy, an A-V fistula was produced by side-to-side anastomosis proximal to the pedicle at the level of the common femoral vessels. Then the flaps were sutured back into their beds. All the island groin flaps with the AVF failed to survive. In Group 3, there was a severe reduction of blood flow in the flap and no flaps survived; however, all the flaps in Group 2 survived totally with no problem. It was concluded that island skin flap circulation is negatively affected by an AVF proximal to the flap pedicle. If the flap and AVF are treated as in Group 2, then flap necrosis caused by reduced blood flow can be overcome in this model.