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The deep venous system and reverse flow flaps

F del Pinal1, G I Taylor

  • 1Department of Anatomy, University of Melbourne, Australia.

British Journal of Plastic Surgery
|December 1, 1993
PubMed
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Preserving microvenous pathways surrounding arteries is crucial for reverse flow flap survival. Disconnecting these vessels significantly increases flap necrosis, highlighting their importance in venous drainage.

Area of Science:

  • Vascular Surgery
  • Anatomy
  • Microsurgery

Background:

  • Reverse flow flaps are essential in reconstructive surgery.
  • Venous valve anatomy and drainage pathways can impact flap viability.
  • Understanding venous connections is critical for surgical success.

Purpose of the Study:

  • To investigate the venous drainage pathways in reverse flow flaps.
  • To determine the role of microvenous connections in flap survival.
  • To assess the impact of venous valve competency on flap viability.

Main Methods:

  • Human cadaveric dissection and radiography to map venous valves.
  • Canine reverse flow saphenous flap model comparing intact vs. skeletonized microvenous pathways.
  • Hemodynamic studies to evaluate venous valve function.

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Main Results:

  • Macrovenous connections are insufficient to bypass venous valves in standard reverse flow flaps.
  • An alternative microvenous pathway (venae arteriosa) surrounding arteries was identified.
  • Non-skeletonized flaps with intact microvenous connections showed high survival rates (subtotal to total).
  • Skeletonized flaps, with disconnected microvenous pathways, experienced 70% total necrosis.

Conclusions:

  • Microvenous pathways are vital for reverse flow flap survival.
  • Preservation of venae arteriosa is critical, especially in skeletonized flaps.
  • Venous valve anatomy and the integrity of both macro- and microvenous systems significantly influence flap outcomes.