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Anatomical Study of Cutaneous Venous Flow of the Palm

Kim, Baek-kyu MD; Kwon, Heeyeon MD; Imanishi, Nobuaki MD; Chang, Hak MD

doi: 10.1097/SAP.0000000000000932
Research

Backgrounds: Various flaps elevated from the palm have been widely used for finger and hand reconstruction. Recently, perforator-based free flaps or venous free flaps have received popularity due to several advantages. The cutaneous venous system has been chosen as the circulatory outlet when designing and harvesting the flap from the palmer area due to the small size and thin nature of the flap. However, there have been few descriptions about the anatomy of the palmar cutaneous veins. A more detailed knowledge will be valuable for elevating various flaps from the palmar area.

Methods: Whole-body and hand venography with a contrast medium was performed on 9 fresh cadavers. Dissection and investigation of the skin and subcutaneous tissue were performed using a soft x-ray system with a stereogram. During all the processes that involved elevating the tissue, observations were made on the macroscopic structure of the palmar vein.

Results: In the palm, a complex network of veins are connected with the distal branches of the cephalic vein, basilic vein, and dorsal venous arch. The pattern and geometric formation of the venous network in all cases showed distinctive features according to each region of the palm. The venous branches create a network extending to palmar margins and webs between fingers.

Conclusions: Venous arrangement should be considered when designing flaps from the palm to prevent venous congestion and safely extend the length of the flap.

From the *Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, †Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea; ‡Departments of Anatomy and Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan; and §Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Received June 28, 2016, and accepted for publication, after revision August 30, 2016.

Conflicts of interest and sources of funding: none declared.

Reprints: Baek-kyu Kim, MD, Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea; Hak Chang, MD, Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. E-mail: plasrecon@gmail.com.

The present study was undertaken in accordance with the Declaration of Helsinki.

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