Venous flap is a composite tissue consisting of skin and vein that provides blood flow for nutrition to the reconstruction site. Types of flaps include: pedicle venous flap (A), venousvenous flow-through venous flap (B-1), arteriovenous flow-through venous flap (B-2), and arterialized flow-through venous flap (B-3). This study describes our experience with the use of three of these flaps in the replantation and revascularisation of the hands.

35 venous flaps (19 B-1, 10 B-2 and 6 B-3) have been used in 34 patients (28 males). Patients ranged in age from 3 to 66 years. 18 were smokers and 13 had preexisting disease such as diabetes, hypertension, or arthritis. 15 flaps were performed during replantations and 20 during digit revascularization. 24 patients had crush injuries, 6 had avulsions, 2 had thermal burns, and one each had clean cut injury and necrosis of skin. Flaps were harvested from the dorsum and volar aspects of the hand and digits, from the forearm, and from the foot. All flaps were performed during or within 5 days of the initial operation. The smallest flap measured 1x1.5-cm and the largest, 8x4-cm. 10 flaps were used to cover exposed muscular, venous, or skeletal structures. 9 were performed following post replantation venous thrombosis, 10 were performed for gaps between the skin defect and veins or arteries.

All patients undergoing venous flap received low molecular weight dextran with heparin and aspirin in the postoperative period for 3-5 days and aspirin for another 4 weeks. 22 flaps survived, 5 flaps failed, one had partial necrosis, 3 failed due to replantation failure and 3 patients were lost to follow-up. Reexploration was successfully performed in 4 patients. Fifty percent of avulsion injury flaps survived. Flap failure was due to infection, initial injury, blood vessel condition, patient overall health , and size of the flap. Survival rate of the flap varied by procedure type and number of proximal and distal anastomoses.

Venous flaps can be used in the management of replantation and revascularization of digits. This is particularly true in procedures involving soft tissue loss in need of venous or arterial reconstruction. It is a valuable salvage procedure for digits that develop late venous insufficiency. Flaps harvested from the digits provides good color and contour matching. Careful attention to microvascular technique when raising, revascularising, and insetting the flap should provide satisfactory survival rate for difficult reconstructive problems.