Salvage of superficial palmar avulsion

Avulsion injuries of the hand caused by moving rollers usually create a distally or, less commonly, a laterally based skin flap. Progressive necrosis in the distant part of the flap usually occurs because of arterial insufficiency and venous stasis over the next 2 to 3 weeks. From 1991 to 1994, we applied the concept of the "arterialized venous flap" to salvage the palmar tissue by revascularizing the superficial palmar venous network with an arterial anastomosis in eight patients. Six of the flaps survived completely and two had a small strip of marginal necrosis which healed secondarily. When compared with conventional methods, this method can remarkably improve the circulation of the flap and provide a better cosmetic and functional result for the highly specialized palmar tissue.