Intermittent Short Saphenous Vein Phlebotomy
- 1 March 2007
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Plastic Surgery
- Vol. 58 (3), 303-307
- https://doi.org/10.1097/01.sap.0000238458.33475.ca
Abstract
Venous congestion is the main cause of failure in the distally based sural artery flap. Herein, we present our technique of phlebotomy to relieve flap congestion. Venous blood is intermittently drained via an exteriorized segment of the short saphenous vein until flap circulation normalizes. From 2000 to 2005, 34 distally based sural artery flaps were performed. In all patients, an extra 5 cm of the short saphenous vein was incorporated with the flap during harvest. Fourteen flaps were noted to be congested after inset. In 2 patients, supercharging was performed. In the remaining 12 patients, intermittent phlebotomy was performed through an externalized segment of the short saphenous vein on the operating table and hourly thereafter until venous congestion improved. All flaps survived. The mean duration of phlebotomy was 30 hours, and mean blood loss in the first 24 hours was estimated to be 94 mL. The color of the flap was noted improved gradually over this period as it established a more efficient venous drainage. Our approach of providing an additional venous outlet for congested flaps contributed to the favorable survival rate noted in this series. Intermittent phlebotomy was a simple and effective way to relieve venous congestion during the immediate postoperative period. As oscillating avalvular veins hypertrophied and multiplied during the ensuing 24–48 hours, venous circulation improved and the short saphenous vein spontaneously stopped draining. Phlebotomy improved flap survival and was a valuable temporizing measure to prevent critical congestion in flaps adapting to a new circulatory pattern.Keywords
This publication has 28 references indexed in Scilit:
- Delaying the Reverse Sural Flap Provides Predictable Results for Complicated Wounds in Diabetic FootAnnals of Plastic Surgery, 2005
- Lower-Limb Reconstruction Utilizing the Reverse Sural Artery Flap???Gastrocnemius Muscle Cuff TechniqueAnnals of Plastic Surgery, 2005
- Reverse Sural Artery Flap: Caveats for SuccessAnnals of Plastic Surgery, 2002
- Reverse-Flow Island Sural FlapPlastic and Reconstructive Surgery, 2002
- Use of Distally Based Superficial Sural Island Artery Flaps in Acute Open Fractures of the Lower LegAnnals of Plastic Surgery, 2001
- The Distally Based Superficial Sural Artery Island Flap: Clinical Experiences and ModificationsPlastic and Reconstructive Surgery, 1998
- The Distally Based Sural Artery FlapAnnals of Plastic Surgery, 1998
- The Superficial Sura I Artery Flap in Distal Lower Third Extremity ReconstructionAnnals of Plastic Surgery, 1998
- The Distally Based Superficial Sural Artery FlapPlastic and Reconstructive Surgery, 1994
- Skin Island Flaps Supplied by the Vascular Axis of the Sensitive Superficial NervesPlastic and Reconstructive Surgery, 1992