Venous flaps to repair the soft tissue defects of the hand
DOI:
https://doi.org/10.2340/jphs.v61.46466Keywords:
Venous flap, hand, skin defectAbstract
Aim: The venous flaps provide a versatile, easy flap choice to repair the dorsal skin defects of the fingers and web spaces. Its thin and pliable nature provides natural coverage for the important delicate structures of the hand such as bone, tendon, joint or neurovascular bundle.
Material and methods: From 2010 to 2025, we used the venous flaps to cover exposed bone, tendon and joint located on the distal phalanx, proximal phalanx, web space and dorsum of the hand in 10 patients. Flaps were unipedicled distally based in nine cases. It was a free venous flap in one case. During the flap elevation, the pedicle of the flap included one superficial vein of the hand and its perivenous areolar tissue.
Results: The size of the flaps ranged from 4 cm2 to 9 cm2. The mean length of the vascular pedicles was 3.1 cm (min: 2 cm, max: 10 cm). In all cases, the flaps survived completely. The donor sites were on the dorsal surface of the hand in nine cases, the volar surface of the wrist in one case. The donor sites were closed primarily in eight cases; skin graft was used in two cases.
Conclusion: The aim of this study was to share our experience regarding the venous flap usage in the hand. Another aim is to remind us of this useful flap, which was not popularized enough despite its versatility and being described 40 years ago.
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References
Nakayama Y, Soeda S, Kasai Y. Flaps nourished by arterial inflow through the venous system: an experimental investigation. Plast Reconstr Surg. 1981;67:328–334. DOI: https://doi.org/10.1097/00006534-198103000-00009
Baek SM, Weinberg H, Song Y, et al. Experimental studies in the survival of venous island flaps without arterial inflow. Plast Reconstr Surg. 1985;75:88–95. DOI: https://doi.org/10.1097/00006534-198501000-00020
Tsai TM, Matiko JD, Breidenbach W, et al. Venous flaps in digital revascularization and replantation. J Reconstr Microsurg. 1987;3:113–119. DOI: https://doi.org/10.1055/s-2007-1006973
Fukui A, Tamai S, Maeda M, et al. The pedicled venous flap. An experimental study. Br J Plast Surg. 1993;46:116–121. DOI: https://doi.org/10.1016/0007-1226(93)90141-W
Noreldin AA, Fukuta K, Jackson IT. Role of perivenous areolar tissue in the viability of venous flaps: an experimental study on the inferior epigastric venous flap of the rat. Br J Plast Surg. 1992;45:18–22. DOI: https://doi.org/10.1016/0007-1226(92)90108-A
Smith RJ, Fukuta K, Wheatley M, et al. Role of perivenous areolar tissue and recipient bed in the viability of venous flaps in the rabbit ear model. Br J Plast Surg. 1994;47:10–14. DOI: https://doi.org/10.1016/0007-1226(94)90110-4
Adamo C, Rubino C. Venous flaps and perivenous areolar tissue: an experimental study in rats. J Reconstr Microsurg. 1996;12:179–181. DOI: https://doi.org/10.1055/s-2007-1006473
Murata K, Tamai S, Inada Y, et al. Transfer of a pedicled venous flap containing perivenous areolar tissue and nerve: an experimental study. Br J Plast Surg. 1999;52:223–229. DOI: https://doi.org/10.1054/bjps.1997.3039
Chavoin JP, Rouge D, Vachaud M, et al. Island flaps with an exclusively venous pedicle. A report of eleven cases and a preliminary haemodynamic study. Br J Plast Surg. 1987;40:149–154. DOI: https://doi.org/10.1016/0007-1226(87)90187-1
Foucher G, Norris RW. The venous dorsal digital island flap or the ‘neutral’ flap. Br J Plast Surg. 1988;41:337–343. DOI: https://doi.org/10.1016/0007-1226(88)90069-0
Murata K, Inada Y, Fukui A, et al. Clinical application of the reversed pedicled venous flap con- taining perivenous areolar tissue and/or nerve in the hand. Br J Plast Surg. 2001;54: 615–620. DOI: https://doi.org/10.1054/bjps.2001.3673
Roberts JM, Carr LW, Haley CT, et al. Venous flaps for revascularization and soft-tissue coverage in traumatic hand ınjuries: a systematic review of the literature. J Reconstr Microsurg. 2020;36:104–109. DOI: https://doi.org/10.1055/s-0039-1695053
Gurdin M, Pangman WJ. The repair of surface defects of fingers by trans-digital flaps. Plast Reconstr Surg (1946). 1950;5: 368–371. DOI: https://doi.org/10.1097/00006534-195004000-00011
Earley MJ, Milner RH. Dorsal metacarpal flaps. Br J Plast Surg. 1987;40:333–341. DOI: https://doi.org/10.1016/0007-1226(87)90035-X
Rezende MR, Mattar R Jr, Cho AB, et al. Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:71–76. DOI: https://doi.org/10.1590/S0041-87812004000200005
Cil Y, Yapici AK, Kocman AE, et al. Distally based venous flap for proximal phalangeal soft tissue burn defect and web space burn contracture. Br J Plast Surg. 2009;30:643–647. DOI: https://doi.org/10.1097/BCR.0b013e3181abffe7
Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg. 1990;43:28–39. DOI: https://doi.org/10.1016/0007-1226(90)90042-X
Lai-jin L, Xu G. The reverse dorsal metacarpal flap: experience with 153 cases. Ann Plast Surg. 2006;56:614–617. DOI: https://doi.org/10.1097/01.sap.0000205775.41405.fa
Shi H, Huang Y, Shen Y, et al. The first dorsal metacarpal artery flaps versus reverse homodigital dorsal flaps for thumb reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg. 2024;26:24–31. DOI: https://doi.org/10.2340/jphs.v59.12435
Suh IS, Han SK, Lee BI, et al. Venous Island flap for reconstruction in the hand. J Korean Soc Plast Reconstr Surg. 2003;30:293–299.
Han S-K, Kim S-Y, Gu JH, et al. Influence of the pedicle orientation and length on viability of unipedicled venous island flaps. Microsurgery. 2014;34:197–202. DOI: https://doi.org/10.1002/micr.22161
Cil Y, Kocman AE, Yapici AK. Distally based venous flap: a new technique for the correction of syndactyly without skin graft in adult patients. Chir Organi Mov. 2009;93:123–129. DOI: https://doi.org/10.1007/s12306-009-0044-0
Davami B, Arasteh E, Pourkhamene G. Versatility of venous flap for coverage of proximal and middle phalanges of fingers. Tech Hand Up Extrem Surg. 2012;16:23–26. DOI: https://doi.org/10.1097/BTH.0b013e31822d5e1c
Shalaby HA, Saad MA. The venous island flap: is it purely venous? Br J Plast Surg. 1993;46:285–287. DOI: https://doi.org/10.1016/0007-1226(93)90003-T
Chang SM. The pedicle of neurocutaneous island flaps. Plast Reconstr Surg. 1996;98:374–376. DOI: https://doi.org/10.1097/00006534-199608000-00038
Chang SM, Gu YD, Li JF. The role of the large superficial vein in survival of proximally based versus distally based sural veno-neuro-fasciocutaneous flaps in a rabbit model. Plast Reconstr Surg. 2005;115:213–218. DOI: https://doi.org/10.1097/01.PRS.0000138255.89687.F4
Krishnan KG. The venous flaps: an experimental study of the microvascular architecture, the area of perfusion and their correlation. Br J Plast Surg. 2002;55:340–350. DOI: https://doi.org/10.1054/bjps.2002.3842
Tang YB, Simchon S, Chen HC. Microcirculation of a venous flap: an experimental study with microspheres in rabbits. Scand J Plast Reconstr Surg Hand Surg. 2000;34:207–212. DOI: https://doi.org/10.1080/02844310050159774
Bayır İ, Kemaloğlu CA, Deniz K. Management of venous flap insufficiency: the role of low molecular weight heparin in salvage. J Plast Surg Hand Surg. 2022;56:285–290. DOI: https://doi.org/10.1080/2000656X.2021.1968417
Ueda K, Tajima S, Tanaka Y, et al. Experimental study of delay of venous island flaps. Ann Plast Surg. 1994;33:519–523; discussion 523–524. DOI: https://doi.org/10.1097/00000637-199411000-00009
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Copyright (c) 2026 Ali Murat Başak, Çağla Çiçek, Arzu Türkseven Topaçoğlu, Hande Akdeniz, Derya Özçelik
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