• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.1-13
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• 2005

Purpose: The purpose of this study is to present extended indications for the use of arterialized venous flaps in reconstructing soft tissue, tendon, nerve, blood vessel, and composite tissue defects of the hand of various sizes based on researches and clinical experiences of the authors. Moreover, procedures to achieve complete flap survival and postoperative results are presented. Materials & methods: This study is based on 154 cases of arterialized venous flaps performed to reconstruct the hand during the past 11 years. The most common cause of injury was industrial accidents with 125 cases. One hundred thirty patients or 84% of the cases had emergency operation within 2 weeks of the injury. The flaps were categorized depending on the size of the flap. Flaps smaller than $10\;cm^2$ were classified as small (n=48), those larger than $25\;cm^2$ classified large (n=42) and those in between medium (n=64). Classified according to composition, there were 88 cases (57.1 %) of venous skin flaps, 28 cases of innervated venous flaps, 15 cases of tendocutaneous venous flaps, which incorporated the palmaris longus tendon, for repair of extensor tendons of the fingers, and 17 cases of conduit venous flaps to repair arterial defect. There were 37 cases where multiple injuries to multiple digits were reconstructed. Moreover, there were 6 cases of composite tissue effects that involved soft tissue, blood vessels and tendons. The donor sites were ipsilateral forearm, wrist and thenar area, foot dorsum, and medial calf. The recipient sites were single digit, multiple digits, first web space, dorsum and palm of hand, and wrist. Results: There were seven cases (4.5%) of emergent re-exploration due to vascular crisis, and 3 cases of flap failure characterized by more than 50% necrosis of the flap. The survival rate was 98.1 % (151/154). In small flaps, an average of 1.01 afferent arteries and 1.05 efferent veins were microanastomosed, and in large flaps, an average of 1.88 afferent arteries and 2.19 efferent veins were anastomosed. In 8 cases where innervated flaps were used for reconstructing the palm of the hand, the average static two-point discrimination was $10\;(8{\sim}15)\;mm$. In 12 cases where tenocutaneous flaps were used, active range of motion at the proximal interphalangeal joint was 60 degrees, 20 degrees at the distal interphalangeal joint, and 75 degrees at the metacarpophalangeal joint. Conclusion: We conclude that the arterialized venous flap is a valuable and effective tool in the reconstruction of hand injuries, and could have a more comprehensive set of indications.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.521-526
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• 2008

Purpose: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures Methods: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. Results: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. Conclusion: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.