Distal arteriovenous fistula to maintain patency of the venous drainage of a latissimus dorsi flap following subclavian vein repair.
Successful reconstructive surgery with muscle flaps depends on adequate arterial supply and undisturbed venous drainage. Combining such surgery with reconstructive vascular surgery of a large-caliber vein that is responsible for the venous drainage of the flap poses an additional challenge--the repaired vein's susceptibility to thrombosis. Every attempt must be made to prevent venous outflow obstruction following muscle flap surgery. Data from the vascular surgery literature demonstrate a low success rate for subclavian vein repair. The success rate with venous reconstructive surgery has been greater when a distal arteriovenous fistula accompanied the repair. The present case described the use of a temporary distal cephalic-brachial arteriovenous fistula to maintain the patency of the venous drainage of a pedicled latissimus dorsi muscle flap, following subclavian vein repair, for one-stage coverage of a large chest wall defect.
Har-Shai
Y
Y
Plastic Surgery Unit, Carmel Medical Center, Haifa, Israel. yaron07@yahoo.com
Karmeli
R
R
Saute
M
M
Mayblum
S
S
Taran
A
A
Barak
A
A
Loberman
Z
Z
Naveh
U
U
Eyal
A
A
Schramek
A
A
D006607:Adenoma, Sweat Gland / Q000098:blood supply / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D001367:Axillary Vein / Q000601:surgery; D001916:Brachial Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012878:Skin Neoplasms / Q000098:blood supply / Q000601:surgery*; D013350:Subclavian Vein / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013899:Thoracic Neoplasms / Q000098:blood supply / Q000601:surgery*; D014654:Vascular Patency / Q000502:physiology*