Veno-Accompanying Artery Fasciocutaneous (VAF) Flap for Coverage of Skin Defects of the Leg and Ankle

Abstract

The veno-accompanying artery fasciocutaneous (VAF) flap and veno-neuro-accompanying artery fasciocutaneous (V-NAF) flap are fasciocutaneous flaps receiving arterial blood supply from accompanying arteries of the cutaneous vein and nerve (Nakajima, 1999). These skin flaps can cover skin defects of the extremities as pedicle flaps. These authors reported the results of these flaps used to cover skin defect of the leg. Since 1996, 17 flaps were used in 17 patients. The mean age of 14 men and 3 women was 42 years (range: 3 to 71 years). Cases involved skin defects in 6 patients, traumatic bone and skin defects in 5, and skin defects after tumor resection and after contracture release in 3 patients each. Four patients had combined osteomyelitis and were treated simultaneously with antibiotic-impregnated bone cement. The size of the skin defect ranged from 4 cm × 3.5 cm to 15 cm × 8 cm. The sural or saphenous nerve was used in V-NAF flaps. Currently, the authors spare these nerves, especially the saphenous nerve, in the proximal leg because it runs under the fascia and makes less of a contribution to the blood supply to the leg. There were 13 flaps containing the small saphenous vein and 4 flaps containing the great saphenous vein. Five proximally-based flaps were used to cover proximal skin defects, as proximal as the popliteal fossa and the prepatellar region. Twelve distally-based flaps were used to cover distal skin defects, as distal as the stump of Chopart amputation. Follow-up ranged from 1 year to 6 years (mean: 2 years). All flaps survived completely. The donor sites of these flaps were closed primarily in 6 and with a skin graft in 11 cases. All osteomyelitis cases healed without any problems. Skin defects exposing bone in the leg and ankle are difficult to treat. Free vascularized flaps used to be required in many cases. However, free flap transfer may be difficult in elderly patients or in patients having disease or damage to major arteries of the leg. The VAF and V-NAF flaps are pedicle flaps, relatively easy to dissect and with no need to sacrifice the major arteries of the leg. They are useful for covering skin defects of the leg and ankle.