Venous flaps in digital revascularization and replantation

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Replantation or revascularization of digits often presents challenges with substantial dorsal soft tissue defects.
• Coverage of these defects is crucial for successful digit salvage and functional recovery.

Observation:

• A venous free flap, characterized by isolated venous inflow and outflow, was utilized to reconstruct dorsal soft tissue defects in 15 patients.
• Postoperatively, the venous flaps demonstrated clinical signs of viability, including warmth, pink coloration, and a blanch-and-refill phenomenon mimicking capillary filling.

Findings:

• Venous free flaps harvested from the dorsal aspect of an uninjured digit achieved a 100% survival rate, with no instances of partial necrosis.
• In contrast, venous free flaps sourced from forearm or dorsal foot donor sites exhibited failure, indicating donor site specificity for flap success.

Implications:

• This technique offers a viable solution for venous drainage and flap coverage in digit reconstruction, potentially avoiding complications associated with skin grafting over venous anastomoses.
• The findings suggest that venous free flaps from uninjured digits are a reliable option for reconstructing soft tissue defects in digit replantation, improving outcomes and minimizing graft-related complications.