title: Palmar contracture release with arterialized venous instep flap: An anatomical and clinical study.
abstract: BACKGROUND
  Plantar skin has similar histologic features to the palmar area and appears to be the ideal tissue for reconstruction of the palmar region. In this study, an anatomic examination was performed to determine the superficial venous architecture of the instep area, and the use of arterialized venous instep flaps for palmar contracture release was assessed.
  
  
  METHODS
  The anatomical study was performed on 12 fresh cadaver feet. The arterialized venous instep flap, including the skin, subcutaneous tissue and superficial venous plexus, was harvested. To determine the venous structure, dissection (n = 6) and injection-corrosion (n = 6) techniques were used. In the clinical study, nine arterialized venous instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia and included skin, subcutaneous fat, and the superficial venous plexus. At the plantar site of the flap, two or three veins, one of which was used, were dissected for a sufficient length for the arterial anastomosis. The saphenous vein was used for the venous anastomosis.
  
  
  RESULTS
  Dissection and injection-corrosion techniques revealed that the flap had 7-12 and 4-6 veins at its plantar and superior edges, respectively, with numerous anastomoses and interconnections between the veins. The flap dimensions were between 3 × 5 cm and 4 × 6 cm. All flaps survived, with two partial flap necrosis that healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps adapted well to the recipient site.
  
  
  CONCLUSIONS
  The arterialized venous instep flap is a good alternative to reconstruct palmar contractures by adding similar tissue that is thin and pliable with minimal donor site morbidity.
authors.affiliation: Gulhane Military Medical Academy, Department of Plastic and Reconstructive Surgery, Ankara, Turkey. Electronic address: fatihzor@yahoo.com.
authors.forename: Fatih
authors.initials: F
authors.lastname: Zor
authors.affiliation: Gulhane Military Medical Academy, Department of Anatomy, Ankara, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Yalçın
authors.affiliation: Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Tekin
authors.affiliation: Gulhane Military Medical Academy, Department of Plastic and Reconstructive Surgery, Ankara, Turkey.
authors.forename: Muhitdin
authors.initials: M
authors.lastname: Eski
authors.affiliation: Gulhane Military Medical Academy, Department of Plastic and Reconstructive Surgery, Ankara, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Işık
authors.affiliation: Gulhane Military Medical Academy, Department of Plastic and Reconstructive Surgery, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Şengezer
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002056:Burns / Q000150:complications; D002102:Cadaver; D003286:Contracture / Q000473:pathology / Q000601:surgery*; D004863:Equinus Deformity / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000033:anatomy & histology / Q000098:blood supply*; D018409:Foot Injuries / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012501:Saphenous Vein / Q000637:transplantation; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arterialized venous flap; Glabrous skin flap; Instep flap; Palmar contracture release