Successful salvage of venous thrombosis of a free flap by creation of a venocutaneous fistula.
Research article published in Journal of reconstructive microsurgery (2011)
Abstract
This report describes the creation of a venocutaneous fistula to salvage a free fibular osteocutaneous flap compromised by extensive venous thrombosis. This technique has previously been described for salvage of digital replants, but this is the first report of a venocutaneous fistula being used to salvage a free flap. A 21-year-old woman underwent a 9-cm resection of the distal left tibia for an aneurysmal bone cyst. A contralateral right fibular osteocutaneous free flap was used for reconstruction. On postoperative day 2, the skin paddle showed evidence of venous congestion. Reexploration demonstrated extensive thrombosis throughout the entire venous system of the flap. The venae comitantes were transected as far back as possible and brought to the surface of the skin through two small stab wounds to allow venous egress. After a short course of heparin and dextran, the skin flap healed uneventfully and both osteosynthesis sites consolidated. A venocutaneous fistula provides a path of relatively low resistance for venous outflow, improving the arterial inflow-venous outflow balance for a short time until neovascularization and collateral venous channels develop. The venocutaneous fistula technique may be considered for salvage of free flaps compromised by extensive venous thrombosis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Successful salvage of venous thrombosis of a free flap by creation of a venocutaneous fistula.
Why This Matters for Hirudotherapy
Jones et al. (2011, J. Reconstr. Microsurg.) report a single case in which a free fibular osteocutaneous flap, compromised by extensive venous thrombosis after distal-tibia reconstruction in a 21-year-old woman, was salvaged by creating a venocutaneous fistula — bringing the transected venae comitantes to the skin surface to provide low-resistance venous outflow until neovascularization developed — with the flap healing after a short course of heparin and dextran. This is directly relevant to the clinical niche where hirudotherapy is used, since medicinal leeches are an established adjunct for relieving venous congestion in failing flaps and replants; the paper describes an alternative surgical egress technique addressing the same arterial-inflow/venous-outflow imbalance that leech therapy targets, useful context for ASH's flap-salvage evidence map. Honest caveats: this is a single case report (lowest level of evidence, not generalizable), it describes a surgical fistula rather than leech therapy, and leeches are not the intervention studied here.
Citation
Successful salvage of venous thrombosis of a free flap by creation of a venocutaneous fistula.
Jones et al. · Journal of reconstructive microsurgery, 2011
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