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Optimizing the Arterialized Venous Flap

Pittet, Brigitte M.D.; Quinodoz, Pierre M.D.; Alizadeh, Navid M.D.; Schlaudraff, Kai-Uwe M.D.; Mahajan, Ajay L. F.R.C.S.I., M.M.Sc.

Plastic & Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - pp 1681-1689
doi: 10.1097/PRS.0b013e31818cbef1
Experimental: Original Articles

Background: Outcome of arterialized venous flaps is quite varied. The authors' initial experiments showed that a good vascular bed contributes significantly to survival of the flap. In continuation of these experiments, this study aimed to understand the influence of architectural variations on flap outcome.

Methods: Fasciocutaneous flaps were designed on the ears of New Zealand rabbits, and the animals were randomized into four groups having flaps that used the larger anterior marginal vein (1.3 mm) or the smaller central vein (0.6 mm) for arterial inflow, with or without isolation of the flap from its bed with a silicone sheet. Flaps were observed for area of flap survival and vasculature was assessed by microangiography.

Results: Using the smaller central vein for arterial inflow (n = 15), arterialized venous flaps had an excellent outcome, with good flap survival in 100 percent of the animals (survival of >85 percent of flap area), and a mean flap survival area of 99.4 ± 1.6 percent. Even when neovascularization was prevented by isolation of the flaps (n = 14), 92 percent of central vein flaps showed good survival, with a mean flap survival area of 93.3 ± 7.3 percent, which was significantly better than that of anterior marginal vein flaps (n = 22), which showed good flap survival in only 27 percent of the animals (mean flap survival area, 76.4 ± 12.1 percent).

Conclusions: Survival of arterialized venous flaps is optimized by using smaller-caliber veins for inflow and reserving larger-caliber veins for outflow. This regulates inflow and avoids high blood pressure, and arterialized venous flaps behave as physiologic flaps do, by not relying on neovascularization for survival.

Geneva, Switzerland

From the Department of Plastic and Reconstructive Surgery, University Hospitals of Geneva.

Received for publication January 27, 2008; accepted May 23, 2008.

Presented in part at the Fourth Annual Meeting of the European Association of Plastic Surgeons, in Strasbourg, France, April of 1993; the Seventh Congress, European Section, of the International Federation for Plastic Reconstructive and Aesthetic Surgery, in Berlin, Germany, June of 1993; the European Congress of Scientists and Plastic Surgeons, in Geneva, Switzerland, September of 2003 (awarded Best Paper Prize); European Association of Plastic Surgeons meeting, in Genoa, Italy, May of 2004; the Irish Association of Plastic Surgeons Meeting, in Galway, Ireland, May of 2007; and the International Plastic Reconstructive and Aesthetic Surgeons Meeting, in Berlin, Germany, June of 2007.

Disclosure: None of the authors has any financial interests to disclose.

Brigitte Pittet, M.D.; Department of Plastic and Reconstructive Surgery; University Hospitals of Geneva; Rue Micheli-du-Crest 24; 1211 Geneva 14, Switzerland; brigitte.pittet-cuenod@hcuge.ch

©2008American Society of Plastic Surgeons