Arterialized venous free flaps--a reconstructive alternative for large dorsal digital defects

Venous free flaps should be considered as potential reconstructive options for large dorsal digital defects with exposed bone, joint and/or extensor tendons, if local flaps are inadequate or unusable. We describe our experience of thirteen venous free flaps in twelve patients with large dorsal digital defects. Our survival rate for these flaps is comparable to the published data. The forearm donor site was closed primarily in all cases with minimal morbidity. The flaps should be monitored with Doppler devices as clinical evaluation is misleading secondary to the venous congestion inherent in these flaps. This reconstructive option has become a well-established procedure in our hands and is the alternate reconstructive method of choice for large dorsal digital defects where local flaps are not usable or inadequate due to complex hand injuries or multiple finger defects.