Repair of soft tissue defect of fingers with modified arterialized venous flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Jing , CHEN Qingzhong , LI Shuang , WANG Yang , WANG Weifeng ,  TAN Jun

Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226001, P.R.China;

Corresponding?author：

TAN Jun, Email: 13906293933@163.com

Keywords：

Arterialized venous flap; finger; soft tissue defect; wound repair; modified method

DOI：

10.7507/1002-1892.201811114

Video：

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Objective To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers.Methods Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft.Results All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm).Conclusion Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.

Citation： CHEN Jing, CHEN Qingzhong, LI Shuang, WANG Yang, WANG Weifeng, TAN Jun. Repair of soft tissue defect of fingers with modified arterialized venous flap. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 475-478. doi: 10.7507/1002-1892.201811114 Copy

1.	徐永清, 何曉清. 皮瓣外科的新進展. 中國修復重建外科雜志, 2018, 32(7): 781-785.
2.	黃良庫, 許玉本, 李鵬, 等. 游離橈動脈掌淺支皮瓣修復手指軟組織缺損. 中國修復重建外科雜志, 2018, 32(7): 955-958.
3.	程定, 胡俊生, 崔樹英, 等. 橈動脈穿支腕橫紋皮瓣橋接修復手指環形缺損療效觀察. 中國修復重建外科雜志, 2017, 31(7): 837-840.
4.	楊煥友, 王斌, 黃蕾, 等. 同指近節指動脈背側支皮瓣修復末節缺失的指中節脫套傷. 中國修復重建外科雜志, 2018, 32(11): 1446-1449.
5.	Nakayama Y, Soeda S, Kasai Y. Flaps nourished by arterial inflow through the venous system: an experimental investigation. Plast Reconstr Surg, 1981, 67(3): 328-334.
6.	謝振榮, 肖軍波, 雷彥文, 等. 提高動脈化靜脈皮瓣成活的幾個關鍵問題. 中華顯微外科雜志, 2011, 34(4): 347-349.
7.	陳文鋒, 李征, 吳立業, 等. 烏拉地爾減少動脈化靜脈皮瓣血流灌注量的作用. 中華顯微外科雜志, 2018, 41(4): 368-370.
8.	Lin YT, Henry SL, Lin CH, et al. The shunt-restricted arterialized venous flap for hand/digit reconstruction: enhanced perfusion, decreased congestion, and improved reliability. J Trauma, 2010, 69(2): 399-404.
9.	Lam WL, Lin WN, Bell D, et al. The physiology, microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects. J Hand Surg Eur Vol, 2013, 38(4): 352-365.
10.	Lin YT, Hsu CC, Lin CH, et al. The position of ‘shunt restriction’ along an arterialized vein affects venous congestion and flap perfusion of an arterialized venous flap. J Plast Reconstr Aesthet Surg, 2016, 69(10): 1389-1396.
11.	Weng W, Zhang F, Zhao B, et al. The complicated role of venous drainage on the survival of arterialized venous flaps. Oncotarget, 2017, 8(10): 16414-16420.
12.	Moshammer HE, Schwarzl FX, Haas FM, et al. Retrograde arterialized venous flap: an experimental study. Microsurgery, 2003, 23(2): 130-134.
13.	李瑞華, 闞世廉, 許效坤, 等. 動脈化靜脈皮瓣兩種灌流方式比較的實驗研究及臨床應用. 中華手外科雜志, 2006, 22(4): 242-244.
14.	劉學貴, 張銘盛, 楊俊貴, 等. 改良動脈化游離靜脈皮瓣的臨床應用. 中華手外科雜志, 2007, 23(4): 224-226.
15.	Giesen T, Forster N, Künzi W, et al. Retrograde arterialized free venous flaps for the reconstruction of the hand: review of 14 cases. J Hand Surg (Am), 2014, 39(3): 511-523.
16.	白印偉, 李征, 余少校, 等. 前臂掌側游離動脈化靜脈皮瓣修復手部皮膚軟組織缺損的療效觀察. 中國修復重建外科雜志, 2014, 28(3): 362-365.
17.	Lombardo GAG, Tamburino S, Tarico MS, et al. Reverse flow shunt restricted arterialized venous free flap. J Hand Surg (Am), 2018, 43(5): 492.e1-492.e5.
18.	楊帥智, 陳祿, 鄭燦鑌, 等. 分葉串聯游離靜脈皮瓣在雙手指近中節軟組織缺損修復中的應用. 中國修復重建外科雜志, 2016, 30(4): 440-443.
19.	黃輝強, 鄭曉東, 張敬良, 等. 微型動脈化靜脈皮瓣修復 50 例指端皮膚缺損. 中華顯微外科雜志, 2016, 39(2): 188-191.
20.	崔建德, 劉學貴, 楊俊貴, 等. 帶掌長肌腱的控制皮下靜脈屬支動脈化靜脈皮瓣在修復手部復合組織缺損中的應用. 中華顯微外科雜志, 2017, 40(2): 195-198.
21.	Nakazawa H, Nozaki M, Kikuchi Y, et al. Successful correction of severe contracture of the palm using arterialized venous flaps. J Reconstr Microsurg, 2004, 20(7): 527-531.

1. 徐永清, 何曉清. 皮瓣外科的新進展. 中國修復重建外科雜志, 2018, 32(7): 781-785.
2. 黃良庫, 許玉本, 李鵬, 等. 游離橈動脈掌淺支皮瓣修復手指軟組織缺損. 中國修復重建外科雜志, 2018, 32(7): 955-958.
3. 程定, 胡俊生, 崔樹英, 等. 橈動脈穿支腕橫紋皮瓣橋接修復手指環形缺損療效觀察. 中國修復重建外科雜志, 2017, 31(7): 837-840.
4. 楊煥友, 王斌, 黃蕾, 等. 同指近節指動脈背側支皮瓣修復末節缺失的指中節脫套傷. 中國修復重建外科雜志, 2018, 32(11): 1446-1449.
5. Nakayama Y, Soeda S, Kasai Y. Flaps nourished by arterial inflow through the venous system: an experimental investigation. Plast Reconstr Surg, 1981, 67(3): 328-334.
6. 謝振榮, 肖軍波, 雷彥文, 等. 提高動脈化靜脈皮瓣成活的幾個關鍵問題. 中華顯微外科雜志, 2011, 34(4): 347-349.
7. 陳文鋒, 李征, 吳立業, 等. 烏拉地爾減少動脈化靜脈皮瓣血流灌注量的作用. 中華顯微外科雜志, 2018, 41(4): 368-370.
8. Lin YT, Henry SL, Lin CH, et al. The shunt-restricted arterialized venous flap for hand/digit reconstruction: enhanced perfusion, decreased congestion, and improved reliability. J Trauma, 2010, 69(2): 399-404.
9. Lam WL, Lin WN, Bell D, et al. The physiology, microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects. J Hand Surg Eur Vol, 2013, 38(4): 352-365.
10. Lin YT, Hsu CC, Lin CH, et al. The position of ‘shunt restriction’ along an arterialized vein affects venous congestion and flap perfusion of an arterialized venous flap. J Plast Reconstr Aesthet Surg, 2016, 69(10): 1389-1396.
11. Weng W, Zhang F, Zhao B, et al. The complicated role of venous drainage on the survival of arterialized venous flaps. Oncotarget, 2017, 8(10): 16414-16420.
12. Moshammer HE, Schwarzl FX, Haas FM, et al. Retrograde arterialized venous flap: an experimental study. Microsurgery, 2003, 23(2): 130-134.
13. 李瑞華, 闞世廉, 許效坤, 等. 動脈化靜脈皮瓣兩種灌流方式比較的實驗研究及臨床應用. 中華手外科雜志, 2006, 22(4): 242-244.
14. 劉學貴, 張銘盛, 楊俊貴, 等. 改良動脈化游離靜脈皮瓣的臨床應用. 中華手外科雜志, 2007, 23(4): 224-226.
15. Giesen T, Forster N, Künzi W, et al. Retrograde arterialized free venous flaps for the reconstruction of the hand: review of 14 cases. J Hand Surg (Am), 2014, 39(3): 511-523.
16. 白印偉, 李征, 余少校, 等. 前臂掌側游離動脈化靜脈皮瓣修復手部皮膚軟組織缺損的療效觀察. 中國修復重建外科雜志, 2014, 28(3): 362-365.
17. Lombardo GAG, Tamburino S, Tarico MS, et al. Reverse flow shunt restricted arterialized venous free flap. J Hand Surg (Am), 2018, 43(5): 492.e1-492.e5.
18. 楊帥智, 陳祿, 鄭燦鑌, 等. 分葉串聯游離靜脈皮瓣在雙手指近中節軟組織缺損修復中的應用. 中國修復重建外科雜志, 2016, 30(4): 440-443.
19. 黃輝強, 鄭曉東, 張敬良, 等. 微型動脈化靜脈皮瓣修復 50 例指端皮膚缺損. 中華顯微外科雜志, 2016, 39(2): 188-191.
20. 崔建德, 劉學貴, 楊俊貴, 等. 帶掌長肌腱的控制皮下靜脈屬支動脈化靜脈皮瓣在修復手部復合組織缺損中的應用. 中華顯微外科雜志, 2017, 40(2): 195-198.
21. Nakazawa H, Nozaki M, Kikuchi Y, et al. Successful correction of severe contracture of the palm using arterialized venous flaps. J Reconstr Microsurg, 2004, 20(7): 527-531.

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