Evaluating the Efficacy and Safety of Venous Flow-Through Flaps in Hand Reconstructive Surgery: A Systematic Review

Venous flow-through (VFT) flaps offer a valuable reconstructive option for the upper extremity due to ease of harvest and low donor-site morbidity. Despite their potential, survival rates are perceived as unpredictable, and their complication profile remains poorly defined. This study reviews surgical outcomes, applications, and challenges of VFT flaps in upper extremity reconstruction.

Following PRISMA guidelines, a computerized search of 5 databases was performed on April 7, 2024, using terms including "forearm," "hands," "digits," "upper extremity," "flaps," "reconstruction," and "venous flow-through." Eligible studies reported detailed application and outcomes of VFT flaps in the forearm and hand; systematic reviews and studies in other anatomic sites were excluded.

Sixty-two studies published from 1989 to 2023 met inclusion criteria, encompassing 999 patients worldwide. Flap dimensions ranged from 1 to 709.5 cm². The overall survival rate was 96.74% (95% CI: 95.62-97.88). Across the cohort, 327 postoperative complications were reported, yielding a 32.73% complication rate (95% CI: 29.89-35.70). Common complications included venous congestion (6.81%, 95% CI: 5.40-8.54), partial necrosis (7.31%, 95% CI: 5.85-9.09), and edema (5.61%, 95% CI: 4.34-7.21). Flap revision surgery was required in 0.63% of cases (n=7, 95% CI: 0.25%-1.29%), while flap failure occurred in 2.50% (95% CI: 1.70-3.67).

VFT flaps demonstrate high survival rates and a generally favorable complication profile in upper extremity reconstruction. Although severe complications are uncommon, rates of congestion, partial necrosis, and edema highlight the importance of careful postoperative monitoring. Further research is needed to clarify outcomes by flap dimensions and VFT flap types to optimize patient selection and surgical planning.