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
This case report describes creation of a venocutaneous fistula to salvage a free fibular osteocutaneous flap that developed extensive venous thrombosis on postoperative day 2, with the flap healing uneventfully after a short course of heparin and dextran. For ASH and hirudotherapy, the report is relevant because venous congestion and thrombosis in compromised flaps and replants represent the same clinical problem that medicinal leeches and leech-derived anticoagulants (e.g., hirudin) are used to address; familiarity with alternative surgical salvage strategies contextualizes the broader management landscape. The key caveat is that this is a single case report with no comparative or long-term data—it does not establish the technique's general efficacy, and the anticoagulation used (heparin and dextran) was not leech-derived, so any connection to hirudotherapy is indirect.
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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