Venous Island Flap for Reconstruction in the Hand

Suh, In Su; Han, Seung Kyu; Lee, Byung Il; Kim, Woo Kyung

Abstract

The venous flap uses skin and superficial veins for the inflow and outflow of its blood supply. In hand reconstruction procedure, the venous island flap can provide a natural appearance and function. Also its elevation is easily obtained, the operation is simple, and a thin flap can be formed. From November 2000 to July 2002, we performed unipedicled venous island flap procedure on the hand over exposed bone, tendon or joint in 16 cases of 14 patients. The donor sites were on the forearm in 2 cases and dorsal surface of the hand in 14 cases. Flaps were proximally based in 4 cases and distally based in 12 cases. The sizes of the flap ranged from 4.5 cm(2) to 25 cm(2) and the pedicles were a minimum 3 cm and a maximum 7 cm. During elevation of the flap, the pedicle of the flap included one superficial vein of hand and its perivenous areoalr tissue. On donor site direct closure was performed in 11 cases and a full thickness skin graft was performed in 5 cases. In the cases in which the pedicle length was less than 4 cm, the flaps completely survived whether the base of the pedicle was proximal or distal. However, in the cases of distally based flaps with pedicle lengths greater than 5 cm and large rotation angle, congestion developed frequently. In the latter cases, we could raise the survival rate through external bleeding using heparin. Finally, flaps survived successfully in 14 cases and partial necrosis developed in 2 cases. However, the latter were healed by conservative treatment.