• Archives of Plastic Surgery
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• v.37 no.2
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• pp.122-128
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• 2010

Purpose: Many descriptions of the digital arterial anatomy including skin territory of the finger have been published. Relatively few studies on venous architecture of the finger have been performed in this area, in part, attributable to the technical difficulties encountered in dissecting small vessels. The purpose of this study is to present the precise microsurgical anatomy of the vein related to the digital artery and venae comitantes of the components. Methods: Arterial and venous anatomy of their relation to the fingers were examined in 38 specimens of two fresh cadavers and 36 clinical cases. All specimens were evaluated grossly, surgical microscopically, or / and light microscopically to observe the three & two-dimensional structure of the artery and joining vein, evidence of the venae comitantes, and venous valve. Results: No longitudinal venae comitantes along the digital artery were found in any specimens. The size of the venae comitantes of each digital artery was much smaller than other vein, but always existed any level of digital artery. One or two venae comitantes in the digital artery ran spiral, oblique, helical, fibrillar, or irregular branched shape. The authors also found the vein of the finger, that had bicuspid valves, but not in venae comitantes. Conclusion: Recently, venous outflow problem rather than arterial circulation is the most common cause tissue failure after microvascular surgery in the hand. Sometimes, if it is not recognized early, there is an increased risk of tissue damage and loss. The authors concluded that this study presents a useful knowledge for the characterization of the venous structure and evidence for venae comitantes like a venule in the digital artery at varying levels of the finger.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.178-183
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• 2024

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs. group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion: Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

• Archives of Plastic Surgery
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• v.46 no.1
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• pp.84-87
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• 2019

With the recent development in microsurgery, the use of a perforator flap has been widely implemented. If the length of the ALT flap pedicle is insufficient despite adequate preoperative planning, pedicle length extension is necessary. We planned for a reverse ALT free flap using the distal vessel of the descending branch for pedicle length extension in the case of ALT perforator branch originating from the proximal portion of the descending branch. For the management of venous congestion, the distal venae comitantes were anastomosed to the proximal venous stump in an antegrade manner, successfully resolving the venous congestion. Modified reverse-flow ALT free flap, wherein the venae comitantes are anastomosed to the proximal vein stump, is a good option that allows for relatively simple pedicle extension within the same operative field when securing an adequate pedicle length is difficult because of the origin of the perforator from the proximal descending branch, unlike the initial surgical plan.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.39
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• pp.14.1-14.4
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• 2017

Tissue defect reconstruction using radial forearm free flap (RFFF) is a common surgical technique whose success or failure is mainly dependent on venous drainage. RFFF has two major venous outflow systems, superficial and deep vein. Drainage methods include combining both systems or using one alone. This review aims to recapitulate the vascular anatomy and network of RFFF as well as shed light on deep vein as a reliable venous drainage system. We also discuss basic evidence for and advantages of single microanastomosis with coalesced vein to overcome technical difficulties associated with the deep vein system.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.21-26
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• 2012

The radial artery superficial palmar branch free flap is based on the perforators of the superficial palmar branch of the radial artery and its venae comitantes. This flap can be used as a sensible flap including palmar cutaneous branch of the median nerve. Forty radial artery superficial palmar branch free flaps were performed at Centum Institute during October 2010 to December 2011. There were 32 males and 8 females and their mean age were 48 years (range 30 to 66 years). The thumb injured in 13 patients, the index finger in 16 patients, the middle finger in 4 patients, the ring finger in 2 patients, and the little finger in 5 patients. The mean size of the flap was $2.5{\times}3.5$ cm(range $2{\times}2.5$ to $3{\times}7$ cm). The donor site was always closed primarily. The overall survival rate was 90.2 percent. The flaps showed well-padded tissue with glabrous skin. All patients have touch sensation and showed 12 mm two point discrimination in an average(range 8 to 15 mm). Donor site morbidity was conspicuous. One patient showed unsightly scar. Early postoperative range of motion of the affected thumb showed slightly limited radial and palmar abduction. But it improved after postoperative 2 months, and patients did not complaint limitation of motion. In conclusion, the radial artery superficial palmar branch free flap can be used as an option for soft tissue reconstruction of finger defects where local or island flaps are unsuitable.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.55-58
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• 2012

We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had $4{\times}3cm$ and $6{\times}5cm$ scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a severe injury to the right superficial temporal vessel because of previous neurosurgical operations. A 15 cm long pedicle defect was needed to reach the recipient facial vessels. For the vascular graft, the descending branch of the lateral circumflex femoral artery and two venae comitantes were harvested. The flap survived well and the skin graft was successful with no notable complications. When an interposition graft is needed in the reconstruction of the head and neck region for which mobility is mandatory to a greater extent, a sufficient length of graft from an anterolateral flap pedicle could easily be harvested. Thus, this could contribute to not only resolving the disadvantages of a venous graft but also to successfully performing a vascular anastomosis.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.51-57
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• 2004

Introduction: To cover the exposed tendons and bones in the foot and hand which need coverage and abundant vascular flow, lateral arm flaps were transferred. Lateral arm flap is a thin and innervated fasciocutaneous flap with a lower lateral cutaneous nerve and posterior radial collateral artery. Materials and methods: From October 1992 through September 2003, we have performed 5 lateral arm flaps for reconstruction of the exposed achilles tendons in 2 cases and the exposed forearm extensors, 2nd to 5th metacarpal bones and scaphoid each 1 case. The causes were traffic accident in 2 cases and machinary injury in 3 cases. Age range was between 31 to 74 (average 50) and all male except 1. Posterior lateral collateral artery and venae comitantes were anastomosed by end to end in 3 cases and vena comitante in 2 cases. Lower lateral cutaneous nerve was anastomosed with a branch of superficial radial nerve in 2 cases. Results: The results were evaluated by survival of the flap, sensory discrimination, cosmesis and comfort in the activities of the daily living. All flaps were survived. Sensory recovery was graded as deep cutaneous pain sensibility in 2 cases. Cosmesis was moderately satisfied and comfort was good except 1 as moderate. Postoperative defatting procedure was done in 1 case and skin abrasion was occurred in 1 case. Conclusion: Lateral arm flap was suitable for coverage of the exposed achilles tendons and exposed forearm extensors, metacarpals and scaphoid in the wrist.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.229-236
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• 2007

Purpose: Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. Methods: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system. Results: Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities. Conclusion: The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.96-102
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• 1997

The gracilis that is frequently used as a donor of free muscle trasfer is appropriate in the muscular shape and vascular position. This muscle is belonged to the second type of muscle group by the classification of the pattern of muscular nutrient vessel. The adductor branch or first perforating branch of deep femoral artery which supplies the proximal 1/3 of this muscle is a dominant one and this is used for the microscopic anastomosis of muscle or musculocutaneous flap. The minor vascular pedicles which enter the distal 1/3 of this of this muscle are branches of the superficial femoral artery and it is 0.5mm in diameter, 2cm in length with two venae comitantes. These minor pedicles supplies distal half of the gracilis muscle. This island musculocutaneous flap using distal vascular pedicle can be used to cover the defect of soft tissue around the distal femoral supra-condylar area, knee joint and proximal tibial condyle area which cause limitation of motion of knee joint, or in the cases that usual skin graft is impossible. The important operative procedure is as follows; The dissection is carried proximally and distally and the entire gracilis muscle including proximal and distal pedicle is completely dissected. After temporary blocking of the proximal vascular pedicle, the adequate muscle perfusion by the distal pedicle is identified and it is rotated to the recipient site around knee joint. The advantages of this procedure are simple, no need of microscopic vascular anastomoses and no significant functional loss of donor site. Especially in the cases of poor condition of the recipient vessel, this procedure can be used effectively. From 1991 to 1996, we performed 4 cases; complete survival of flap in 3 cases and partial survival of flap with partial necrosis in 1 case. This procedure is though to be useful in the small sized soft tissue defect of distal femoral supra-condylar area, knee joint and proximal tibial condylar area, especially in the defect of anterior aspect which expected to cause limitation of motion of knee joint due to scar contracture. But the problems of this procedure are the diameter of distal vascular pedicle is small and the location of distal vascular pedicle is not constant. To reduce the failure rate, identify the muscular perfusion of distal vascular pedicle after blocking the proximal pedicle, or strategic delay will be helpful.