J reconstr Microsurg 2020; 36(02): 104-109
DOI: 10.1055/s-0039-1695053
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Flaps for Revascularization and Soft-Tissue Coverage in Traumatic Hand Injuries: A Systematic Review of the Literature

John M. Roberts
1  Division of Plastic Surgery, Department of Surgery, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania
,
Logan W. Carr
1  Division of Plastic Surgery, Department of Surgery, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania
,
Christopher T. Haley
2  Department of Dermatology, Baylor Scott and White Health, Texas A&M Health Science Center, Texas A&M University, Temple, Texas
,
Randy M. Hauck
1  Division of Plastic Surgery, Department of Surgery, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania
,
Brett F. Michelotti
3  Department of Plastic Surgery, University of Wisconsin–Madison, Madison, Wisconsin
› Author Affiliations
Further Information

Publication History

17 April 2019

07 July 2019

Publication Date:
27 August 2019 (online)

Abstract

Background The use of the venous flap for simultaneous revascularization and coverage of soft tissue defects has been documented in the literature for over 30 years. First described in 1981, Nakayama et al demonstrated that a vein and overlying skin, or a venous flap, may be transposed from one area of the body to another with complete survival of the graft. The aim of this study was to conduct a systematic review of the literature to determine predictors of venous flap survival in traumatic hand injuries.

Methods A literature search of PubMed, MEDLINE, and Cochrane Library was performed with emphasis on venous flap use in traumatic hand injuries. MeSH terms included: vein graft, revascularization, venous flow through flap, arterialized venous flap, bypass, replantation, amputation, avulsion, trauma, injury, amputate, finger, hand, and thumb.

Results Forty-three articles were collected that contained data on 626 free venous flaps. Most patients were males (73.9) and injured their right hand (52.3%). The forearm was the most commonly used venous flap donor site (83.6%), and most of the skin paddles were 10 to 25 cm2 (41.1%). Arterial inflow was used in 93.1% of the flaps. Most venous flaps (79.6%) healed without superficial tissue loss or necrosis. Ninety-two (14.7%) flaps had partial loss while 36 (5.8%) flaps did not survive.

Conclusion The use of venous flaps for concomitant revascularization and soft tissue coverage of the hand permits good results with limited morbidity. The overall flap survival rate is nearly 95%. Younger patients whose flaps have arterial inflow and skin paddles of medium size (10–25 cm2) have the best chance for survival.