Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap
<i>Background and Objectives</i>: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an immediate visible refill after reconnection, with a similar behaviour to conventional flaps. Therefore, the dimension...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/8/1065 |
| _version_ | 1797431975051526144 |
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| author | Thomas Giesen Olga Politikou Ivan Tami Maurizio Calcagni |
| author_facet | Thomas Giesen Olga Politikou Ivan Tami Maurizio Calcagni |
| author_sort | Thomas Giesen |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an immediate visible refill after reconnection, with a similar behaviour to conventional flaps. Therefore, the dimensions and the indications of these flaps can be extended beyond what was previously believed, and they can be easily customized, including with respect to tendons and nerves. Nevertheless, they are still debated and regarded as unsafe. <i>Materials and Methods</i>: From 2012 to 2019, we performed 31 retrograde free venous flaps on 31 patients to reconstruct hands, digits, and in one case the heel. All the flaps were arterialized in a retrograde manner; the donor site was the forearm in 28 cases, the foot in 2 cases, and the calf in 1 case. We recorded the size, vein architecture, donor site, donor artery, donor morbidity, function for composite and non-composite flaps, immediate complications, late complications, survival rate, and the number of revisions. We recorded the hand function when appropriate. A total of 10 flaps were also intraoperatively studied with indocyanine green to monitor their hemodynamical behaviour. <i>Results</i>: All the patients were followed for an average of 8 months (6–15). The flap dimensions ranged from 6 cm<sup>2</sup> to 136 cm<sup>2</sup>. All the flaps, except two that had complete necrosis, survived. Two flaps had partial necrosis. There was no correlation between necrosis and the size of the flap, with one case of necrosis and one of partial necrosis in the small flaps (<10 cm<sup>2</sup>). None of the cases with partial necrosis needed a new flap. Two flaps developed a late arterio-venous shunt that was ligated. <i>Conclusions</i>: The retrograde free venous flaps proved to be a useful tool for complex reconstructions of the hand and extremities. They can provide a large island of pliable skin and composite tissue with tendons and nerves, but surgeons must be aware of some caveats. |
| first_indexed | 2024-03-09T09:53:06Z |
| format | Article |
| id | doaj.art-aae2b533952a4a06bb3d191d55c25c4d |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T09:53:06Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-aae2b533952a4a06bb3d191d55c25c4d2023-12-01T23:58:41ZengMDPI AGMedicina1010-660X1648-91442022-08-01588106510.3390/medicina58081065Retrograde Free Venous Flaps for Extremity Reconstruction: A RoadmapThomas Giesen0Olga Politikou1Ivan Tami2Maurizio Calcagni3Centro Manoegomito, Clinica Ars Medica, 6900 Gravesano, SwitzerlandDepartment of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, SwitzerlandCentro Manoegomito, Clinica Ars Medica, 6900 Gravesano, SwitzerlandDepartment of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland<i>Background and Objectives</i>: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an immediate visible refill after reconnection, with a similar behaviour to conventional flaps. Therefore, the dimensions and the indications of these flaps can be extended beyond what was previously believed, and they can be easily customized, including with respect to tendons and nerves. Nevertheless, they are still debated and regarded as unsafe. <i>Materials and Methods</i>: From 2012 to 2019, we performed 31 retrograde free venous flaps on 31 patients to reconstruct hands, digits, and in one case the heel. All the flaps were arterialized in a retrograde manner; the donor site was the forearm in 28 cases, the foot in 2 cases, and the calf in 1 case. We recorded the size, vein architecture, donor site, donor artery, donor morbidity, function for composite and non-composite flaps, immediate complications, late complications, survival rate, and the number of revisions. We recorded the hand function when appropriate. A total of 10 flaps were also intraoperatively studied with indocyanine green to monitor their hemodynamical behaviour. <i>Results</i>: All the patients were followed for an average of 8 months (6–15). The flap dimensions ranged from 6 cm<sup>2</sup> to 136 cm<sup>2</sup>. All the flaps, except two that had complete necrosis, survived. Two flaps had partial necrosis. There was no correlation between necrosis and the size of the flap, with one case of necrosis and one of partial necrosis in the small flaps (<10 cm<sup>2</sup>). None of the cases with partial necrosis needed a new flap. Two flaps developed a late arterio-venous shunt that was ligated. <i>Conclusions</i>: The retrograde free venous flaps proved to be a useful tool for complex reconstructions of the hand and extremities. They can provide a large island of pliable skin and composite tissue with tendons and nerves, but surgeons must be aware of some caveats.https://www.mdpi.com/1648-9144/58/8/1065hand reconstructionextremities reconstructionreconstructive microsurgeryflapsfree flapsfree venous flaps |
| spellingShingle | Thomas Giesen Olga Politikou Ivan Tami Maurizio Calcagni Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap Medicina hand reconstruction extremities reconstruction reconstructive microsurgery flaps free flaps free venous flaps |
| title | Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap |
| title_full | Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap |
| title_fullStr | Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap |
| title_full_unstemmed | Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap |
| title_short | Retrograde Free Venous Flaps for Extremity Reconstruction: A Roadmap |
| title_sort | retrograde free venous flaps for extremity reconstruction a roadmap |
| topic | hand reconstruction extremities reconstruction reconstructive microsurgery flaps free flaps free venous flaps |
| url | https://www.mdpi.com/1648-9144/58/8/1065 |
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