Head and Neck Reconstruction with Venous Flap: A Case Report

Venous flaps are nonphysiologic flaps in which the venous system replaces the vascular circuit found in conventional flaps, serving as inflow as well as outflow. Although a main concern with venous flaps has been their reliability, this can be improved by manipulating their physiology using shunt restriction. The soft, pliable tissue provided by venous flaps coupled with the low donor site morbidity and ease of flap harvest make them ideal for coverage of moderate-sized facial defects, which may be too large for local options yet too small for conventional free flaps. We report the use of a large, 70 cm² arterialized venous free flap to reconstruct a complex forehead deficit after basal cell carcinoma resection. Furthermore, we present the first report of the successful use of valvulotomes in the case of a large, reverse flow arterialized venous flap where several in-series valves were found to prevent adequate perfusion of the flap. Upon removal of the valves, complete perfusion of the flap was achieved.