title: Retrograde arterialized free venous flaps for the reconstruction of the hand: review of 14 cases.
abstract: OBJECTIVE
  Although the literature is encouraging with regard to the survival rate of arterialized free venous flaps, previously reported difficulty in healing owing to early venous congestion and subsequent epidermolysis continues to prevent their widespread application. We report 14 arterialized free venous flaps for primary reconstruction of the hand, with inflow in the arterialized vein running against the valves.
  
  
  METHODS
  Between February 2010 and May 2012, we performed 14 arterialized free venous flaps, each of which included at least 2 veins running in parallel. The arterialized vein was anastomosed in a retrograde manner, with the inflow running against the valves. All flaps were customized with regard to dimension, shape, quality of skin, pedicle length, vessel size, inclusion of additional anatomical structures, and donor site. The flaps were used to cover small, medium, and large defects; 2 flaps were larger than 100 cm(2). Three flaps were injected with indocyanine green on the table after harvesting, to visualize the vascular tree of the flap. These 3 flaps were then monitored with systemic indocyanine green injection and an infrared camera for 3 days postoperatively.
  
  
  RESULTS
  All but 1 flap survived. Venous congestion and epidermolysis were observed in 2 small flaps. The flaps injected with indocyanine green displayed a ramified vascular tree with no arteriovenous flow-through phenomenon.
  
  
  CONCLUSIONS
  Arterialized free venous flaps with retrograde arterial flow offer thin and pliable coverage that fits easily around the contours of the hand. They are easy to harvest, with little donor site morbidity. Tendons or nerves can be incorporated for reconstruction of composite defects.
  
  
  CONCLUSIONS
  Our series suggests the possibility of routine use of a free venous flap with retrograde arterial flow for reconstruction of the hand.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland. Electronic address: t_giesen@hotmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Giesen
authors.affiliation: Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Natasha
authors.initials: N
authors.lastname: Forster
authors.affiliation: Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Künzi
authors.affiliation: Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
authors.affiliation: Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Calcagni
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery
keywords: Free venous flap; arterial flow against the valves; reconstruction of the hand