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Immediate and Delayed Use of Arteriovenous Fistulae in Microsurgical Flap Procedures: A Clinical Series and Review of Published Cases

Oswald, Tanya M. MD; Stover, Stephanie A. MD; Gerzenstein, Jacob MD; Lei, M P. MD; Zhang, Feng MD, PhD; Muskett, Allen MD; Hu, Eric MD; Angel, Michael F. MD; Lineaweaver, William C. MD

doi: 10.1097/
Advances in Plastic Surgery

In microsurgical flap procedures, creation of an arteriovenous fistula (AVF) is a technique of vein grafting where the vein graft is connected to recipient vessels as a flow-through loop prior to harvest and inset of the flap. Controversy exists whether this technique can be used as a 2-stage procedure with the loop and flap transfer accomplished in sequential operations or if the loop and flap transfer should be performed in a single operation.

We performed 12 consecutive 1-stage AVF-flap procedures, with 1 flap failure. We combined this series with previously published reports to compare outcomes of 1-stage and 2-stage procedures. We found no significant difference in flap outcomes or complication rates between the 2 strategies. We conclude from our experience and this analysis that single-stage AVF-flap procedures are the optimum application of this technique.

Twelve consecutive single-stage AV fistula procedures with vein grafting were performed for free flap vascularization with only 1 flap failure. The single-stage method was found to be preferable to a 2-stage procedure.

From the Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS.

Received September 21, 2006 and accepted for publication October 5, 2006.

This material was presented in part at the 46th Annual Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, Palm Beach, FL, June 3, 2003.

Reprints: William C. Lineaweaver, MD, Division of Plastic Surgery, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.