title: Optimizing the arterialized venous flap.
abstract: BACKGROUND
  Outcome of arterialized venous flaps is quite varied. The authors' initial experiments showed that a good vascular bed contributes significantly to survival of the flap. In continuation of these experiments, this study aimed to understand the influence of architectural variations on flap outcome.
  
  
  METHODS
  Fasciocutaneous flaps were designed on the ears of New Zealand rabbits, and the animals were randomized into four groups having flaps that used the larger anterior marginal vein (1.3 mm) or the smaller central vein (0.6 mm) for arterial inflow, with or without isolation of the flap from its bed with a silicone sheet. Flaps were observed for area of flap survival and vasculature was assessed by microangiography.
  
  
  RESULTS
  Using the smaller central vein for arterial inflow (n = 15), arterialized venous flaps had an excellent outcome, with good flap survival in 100 percent of the animals (survival of >85 percent of flap area), and a mean flap survival area of 99.4 +/- 1.6 percent. Even when neovascularization was prevented by isolation of the flaps (n = 14), 92 percent of central vein flaps showed good survival, with a mean flap survival area of 93.3 +/- 7.3 percent, which was significantly better than that of anterior marginal vein flaps (n = 22), which showed good flap survival in only 27 percent of the animals (mean flap survival area, 76.4 +/- 12.1 percent).
  
  
  CONCLUSIONS
  Survival of arterialized venous flaps is optimized by using smaller-caliber veins for inflow and reserving larger-caliber veins for outflow. This regulates inflow and avoids high blood pressure, and arterialized venous flaps behave as physiologic flaps do, by not relying on neovascularization for survival.
authors.affiliation: Geneva, Switzerland From the Department of Plastic and Reconstructive Surgery, University Hospitals of Geneva.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pittet
authors.forename: Pierre
authors.initials: P
authors.lastname: Quinodoz
authors.forename: Navid
authors.initials: N
authors.lastname: Alizadeh
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Schlaudraff
authors.forename: Ajay L
authors.initials: AL
authors.lastname: Mahajan
mesh_terms: D000792:Angiography; D000818:Animals; D001158:Arteries / Q000502:physiology / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D004431:Ear, External / Q000098:blood supply* / Q000601:surgery*; D008833:Microcirculation / Q000502:physiology; D023421:Models, Animal; D018919:Neovascularization, Physiologic / Q000502:physiology; D011817:Rabbits; D012039:Regional Blood Flow / Q000502:physiology*; D013524:Surgical Flaps / Q000098:blood supply*; D014680:Veins / Q000502:physiology / Q000601:surgery