A Simplification for Harvesting Medial Plantar Venous Flap With Communicating Veins: Usefulness of Preoperative Ultrasound Imaging

Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation

BACKGROUND

There have been many reports about venous flaps, which are often used for the reconstruction of soft tissue defects after finger injury because such flaps are simple to elevate. Recently, high viability rates and nearly normal histological findings were reported for venous flaps, although the mechanism of flap survival remains unclear. This study investigated the esthetic outcomes after the reconstruction of volar finger defects with free medialis pedis venous flaps, which are venous flaps that elevated between the submalleolar and medial plantar regions.

MATERIALS AND METHODS

Reconstruction of volar finger defects was performed in 6 patients. All flaps were arterialized flow-through flaps with the venous anastomosis as the outflow. All 6 patients were men, with a mean age of 32.0 years. The defect involved the finger shaft in 4 patients and the finger pulp in 2 patients, and the mean size of the venous flap was 16.7 mm (width) × 34.2 mm (length). Five plastic surgeons specializing in maxillofacial surgery evaluated the color match of the flaps at 6 months postoperatively by assigning a score (maximum: 5 points).

RESULTS

The flap showed complete viability with little postoperative atrophy in all 6 patients. The mean color match score for the flaps was 3.7, and it decreased as the flaps were raised further from the medial plantar region.

CONCLUSION

Free medialis pedis venous flaps can be used for the reconstruction of volar soft tissue defects of the finger. Acceptable esthetic results can be obtained if flaps are harvested from an appropriate location in the medialis pedis region by a suitable method.

Systematic Review and Meta-Analysis of Unconventional Perfusion Flaps in Clinical Practice

BACKGROUND

Although unconventional perfusion flaps have been in clinical use since 1975, many surgeons are still deterred from using them, because of some reports of high necrosis rates.

METHODS

The authors performed a systematic review and meta-analysis of all articles written in English, French, German, Spanish, and Portuguese on the clinical use of unconventional perfusion flaps and indexed to PubMed from 1975 until July 15, 2015.

RESULTS

A total of 134 studies and 1445 patients were analyzed. The estimated survival rate of unconventional perfusion flaps was 89.5 percent (95 percent CI, 87.3 to 91.3 percent; p < 0.001). Ninety-two percent of unconventional perfusion flaps (95 percent CI, 89.9 to 93.7 percent; p < 0.001) presented complete or nearly complete survival. Most defects mandating unconventional perfusion flap reconstruction were caused by trauma (63.6 percent), especially of the hand and fingers (75.1 percent). The main complication of all types of flaps was a variable degree of necrosis (7.5 percent of all unconventional perfusion flaps presented marginal necrosis; 9.2 percent and 5.5 percent had significant and complete necrosis, respectively). There was a positive correlation between the rate of postoperative infection and the need for a new flap (Pearson coefficient, 0.405; p = 0.001). Flaps used to reconstruct the upper limb showed better survival than those transferred to the head and neck or to the lower limb (p < 0.001).

CONCLUSION

Unconventional perfusion flaps show high survival rates and should probably be used more liberally, particularly in the realm of upper limb reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, V.