Arch Craniofac Surg.  2015 Dec;16(3):143-146. 10.7181/acfs.2015.16.3.143.

Direct Open Venous Drainage: An Alternative Choice for Flap Congestion Salvage

• Park SH
• Choi WY
• Son KM
• Cheon JS
• Yang JY

• KMID: 2132607
• DOI: http://doi.org/10.7181/acfs.2015.16.3.143

Abstract

In this report, we present a scalp defect reconstruction with lateral arm free flap. We highlight the difficulty in obtaining a recipient vein and the venous drainage managed through an open end of the donor vein. A 52-year-old woman presented with a pressure sore on the left scalp. A lateral arm free flap was transferred to cover this 8x6 cm defect. The arterial anastomosis was successful, but no recipient vein could be identified within the wound bed. Instead, we used a donor venous end for the direct open venous drainage. In order to keep this exposed venous end patent, we applied heparin-soaked gauze dressing to the wound. Also, the vein end was mechanically dilated and irrigated with heparin solution at two hour intervals. Along with fluid management and blood transfusion, this management was continued for the five days after the operation. The flap survived well without any complication. Through this case, we were able to demonstrate that venous congestion can be avoided by drainage of the venous blood through an open vessel without the use of leeches.

Keyword

Salvage therapy; Leeches; Free tissue flaps; Heparin

MeSH Terms

Arm
Bandages
Blood Transfusion
Drainage*
Estrogens, Conjugated (USP)*
Female
Free Tissue Flaps
Heparin
Humans
Hyperemia
Leeches
Middle Aged
Pressure Ulcer
Salvage Therapy
Scalp
Tissue Donors
Veins
Wounds and Injuries
Estrogens, Conjugated (USP)
Heparin