Venous Flap Coverage of the Mangled Hand

Mangled upper-extremity injuries represent composite tissue injuries that threaten the viability or function of the limb. Successful reconstruction is critical to both the patient's mental and physical well-being, and early soft tissue coverage is necessary to best facilitate this. Since first described by Nakayama almost four decades ago, venous flaps have remained underused in microsurgery. Here, we discuss the advantages of venous flaps in mangled upper-extremity soft tissue coverage, including their thin, pliable nature with easily accessible donor sites, short dissection, and overall procedure times. We outline surgical techniques to facilitate successful tissue transfer and identify common pitfalls.