Superficial Venous System Research Articles

DC-CRP: Deep Cerebral Venous Thrombosis, Clinicoradiological Profile, and Treatment Outcome in Indian Population-A Tertiary Care Experience.

Deep cerebral venous thrombosis (DCVT) is an uncommon cause of stroke with diverse predisposing factors, clinical presentations, imaging findings, and functional outcomes, which makes the diagnosis of DCVT even more challenging. Retrospective observational study (December 2018 to January 2023). Cases with imaging data suggestive of DCVT were included. The neuroradiological assessment was performed using multimodality imaging to determine the location of parenchymal changes and the number of deep veins involved in isolation or with the superficial dural venous system. Clinical variables were tabulated. Of the 206 cases with CVT in the study period, 27 had DCVT (13.1%), of which four (14.8%) had isolated DCVT (male-to-female ratio 13:14; mean age = 33.4 years). Hyperhomocysteinemia (n = 11) is the most common risk factor associated with it. The most common presentations were headaches (n = 27) and focal motor deficits (n = 13). Raised intracranial tension (ICT) was present in almost half of the study population (n = 14). Mean and median modified Rankins score (mRS) at the time of discharge were 2.0 and 1, respectively. The most common deep vein involved was the straight sinus (SS) (n = 25), followed by the internal cerebral vein (n = 23). The mean and median mRS after 3 months from discharge were 0.3 and 0, respectively. A knowledge of diverse clinical presentations in DCVT, its neurovascular anatomy, and imaging characteristics with prompt diagnosis and timely interventions can assist in attenuating the risk of acute complications and long-term sequelae. Extensive deep grey matter involvement in DCVT is associated with neurological manifestations like altered sensorium and motor deficits, with increased severity of illness as measured by the mRS score.

Turbocharging of Deep to Superficial Venous System for Vessel Depleted Neck in Radial Forearm Free Flap: A Case Report of One Neck Vein for Drainage of Both Venous Systems

Dual venous anastomosis in radial forearm free flap surgery increases chances of flap survival as compared to anastomosing only the superficial system. A 48-year-old male patient who had received three previous microsurgical reconstructions and radiotherapy presented with recurrent oral cavity carcinoma. Two of these reconstructions were anastomosed to the left side neck vessels. The recurrence was in the left half of the soft palate. The left neck and underlying vessels were severely scarred and fibrotic, and only 2 cm of the left internal jugular vein (IJV) could be circumferentially mobilized for anastomosis, allowing for only one venous anastomosis. The radial forearm free flap was harvested and a tributary of the cephalic vein was preserved in the proximal part to act as a conduit for drainage of one of the venae comitantes. The cephalic vein was anastomosed end-to-side to the IJV and one venae comitantes to the preserved tributary in end-to-end fashion. The flap survived and the patient was discharged in a week. This novel method helps to drain both venous systems through one available neck vein.

Absence of a Deep Vein and the Significance of Drainage from the Superficial Venous System for CME Credit June 2024

Absence of a Deep Vein and the Significance of Drainage from the Superficial Venous System for CME Credit June 2024

Absence of a Deep Vein and the Significance of Drainage from the Superficial Venous System

We submit a case of a 57-year-old man who presented to the Vascular Clinic seeking treatment for worsening varicosities in the left lower extremity. Specifically, these veins were located in the left lateral thigh. He had lost a considerable amount of weight and the varicosities had become more visible and painful. Duplex imaging was performed and revealed non-visualization of the left external iliac and common femoral veins. These findings were confirmed by both computed tomography (CT) imaging and lower extremity venography with fluoroscopy. It was deemed that the great saphenous vein was providing drainage from the limb and, therefore, should not be ablated. Duplex ultrasound was crucial in identifying the abnormal anatomy and planning the subsequent care of the patient. We are reporting this case because of its rarity and to provide awareness.

Convergence of the right and left external jugular veins to the midline: a rare finding of anatomical variation

Venous blood from the head and neck are drained mainly by the internal and external jugular veins. The external jugular vein is located in the anterolateral region of the neck taking a complex pathway perpendicularly down the neck to join the subclavian vein, however, there can be anatomical variations that affect its course. To describe an anatomical variation in the left and right external jugular veins discovered during the dissection of a cadaver in Human Anatomy class. The present study is a case report describing an anatomical variation in the external jugular veins observed during a routine dissection for Human Anatomy class at the Faculty of Medical Sciences of Minas Gerais on an adult male cadaver of unknown age, preserved in formaldehyde solution. the dissection showed that the right and left external jugular veins converged toward the midline, joining just above the level of the jugular notch. Knowledge of variations in the neck superficial venous system is crucial to avoid complications from medical procedures. The present variation was not found described in the literature.

Asociación entre sistemas venosos insuficientes y manifestaciones clínicas en enfermedad venosa crónica de miembros inferiores

Introduction: The clinical, etiological, anatomical, and pathophysiological classification (CEAP) standardizes the manifestations of lower limb venous disease. Objective: To investigate the association between insufficient venous systems and the clinical classification of CEAP. Methods: A quantitative, cross-sectional, analytical, correlational study was conducted. Sampling was non-probabilistic and convenience-based. The sample size was 136 lower limbs from 71 patients. Chi-square, Monte Carlo and Odd ratio (OR) statistical tests were used with 95% confidence intervals through bivariate logistic regression (p<0.05). Results: 71.8% of the subjects were female, with an average age of 66.1 years. The most frequent insufficient venous system was the superficial system, present in 61.7% of cases. 100% of the dilated great saphenous veins (GSV) had insufficiency. The most common CEAP clinical class was C2 (44.9%); 35.1% of C1 (telangiectasia) cases had an insufficient venous system; 50% of C2 cases had GSV insufficiency (p=0.227). There was an association between the insufficiency of both superficial and deep venous systems and the CEAP clinical classification (p=<0.001). The deep venous system was associated with severe chronic venous disease of the lower limbs, OR (6.04) with a 95% CI (1.02-35.73) and p=0.047. Conclusions: The study demonstrated an association between the insufficiency of both superficial and deep venous systems and the CEAP clinical classification. One third of the lower limbs with C1 (telangiectasias) had an insufficient venous system.

Anatomical variations in the superficial venous system of the neck: an image-based study using contrast-enhanced computed tomography.

The superficial venous system (SVS) of the neck receives blood from the face and oral cavity. The SVS comprises the anterior jugular vein (AJV), external jugular vein (EJV), and facial vein (FV). Comprehensive knowledge of the normal anatomy and potential variations in the venous system is valuable in surgical and radiological procedures. This study aimed to update the anatomic knowledge of the SVS using a radiographic approach, which is a beneficial data source in clinical practice. Contrast-enhanced computed tomography images of the neck of patients with head and neck cancer treated between 2017 and 2020 were retrospectively evaluated. Each side of the neck was counted separately. A total of 302 necks of 151 patients were enrolled in this study. The medial AJV was absent in 49.7% (75/151) of the patients on the left side, which was significantly greater than the 19.2% (29/151) on the right (p < 0.001). The left AJV drained into the right venous system in 6.6% (10/151) of the necks. In 48.3% (146/302) of the necks, the FV did not flow into the internal jugular vein but rather into the EJV or AJV; these findings were significantly more frequent than those reported in previous studies. The diameters of the veins were significantly larger when they received blood from the FV than when they were not connected to the FV. These findings indicate that the AJV has a rightward preference during its course. The course of the FV is diverse and affects the diameter of connected veins.

Microsurgical excision of intracranial arteriovenous malformation

Objectives: Brain Arteriovenous malformations are high-flow cerebrovascular lesions with dysplastic vascular nidus, fed by arteries and drained by veins without intervening capillaries. Prevalence is 0.2% and is an important cause of intracerebral haemorrhage in about 38% of young adults. The objective of this study is to analyze surgically managed Intracranial AV malformations with respect to their demographic features, varied clinical presentations, imaging features Spetzler Martin grading and outcome. Methods: A study of 48 patients with Intracranial Arteriovenous malformations who underwent microsurgical excision at the Institute of Neurosurgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai over a period of 5 years from July 2018 to June 2022 and extracted their data including demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, complications and outcome were assessed. Results: Of the 48 patients treated with microsurgery, the most common 51% belongs to the age group between 21 to 40years, left-sided is slightly more common with headache major symptom, involving Parietooccipital lobe 33% commonly, 28 (62.2%) patients initially presented with haemorrhage. Anterior circulation artery feeders was common 68.8% and mostly drainage involving superficial venous drainage system. Based on the Spetzler-Martin (SM) grading system, the patients were graded as follows: 6(13 %) Grade I, 10(21%) Grade II, 25(52%) Grade III, 3 (6%) Grade IV and 4(8%) Grade V. Overall, 35(73%) patients had a favorable outcome, most commonly seen in Grade I, II and Grade III. Almost complete obliteration of the AVMs were achieved in all favorable outcome cases. Conclusion: Microsurgical excision is the gold standard treatment of choice for low grade AVMs and certain high-grade AVMs with increased risk of rupture. The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Proper patient selection combined with appropriate preoperative evaluation, meticulous surgical technique and postoperative care all lead to reduced mortality and morbidity.

A cadaveric study and clinical application of the free superficial circumflex iliac artery perforator flap reconstruction of limb soft tissue defects

Introduction In recent decades the superficial circumflex iliac artery perforator (SCIP) flap technique has gradually overcome the previous disadvantages of its pedicle and donor site to be widely applied in treating tissue's defects. This article investigates the vascular anatomy of the SCIP flap and evaluates the result of using the flap to reconstruct limb defects. Materials and Methods The study was performed in two parts. Firstly a cross-sectional descriptive anatomical study comprising 49 groin dissections in 25 cadavers, with contrast radiographic demonstration of the vascular anatomy. Secondly a retrospective case series of 51 free SCIP flaps in 49 patients. Surgical outcomes were evaluated using the Vancouver Scar Scale on the regional function and the aesthetics of implanted flap and donor sites. Results The results of anatomical analysis on cadavers showed the superficial circumflex iliac arteries were detected in all specimens with an average diameter of 1.4 ± 0.3 mm. The superficial subcutaneous venous systems were also recorded, including two veins (superficial circumflex vein and superficial epigastric vein) in 79.5% with an average diameter of 2.3 ± 0.6 mm. The flap results showed the alive flap rate was 90.2%, partial-necrosis flap was 3.9% and total necrosis of the flap in 5.9%. In the aesthetic evaluation, fine line scars were seen in 13/51 cases (25.5%), stretch scars in 33/51 cases (64.7%) and hypertrophic scars in 5/51 patients (9.8%), with no cases of keloid scars. Conclusion The SCIP flap is a reliable free-tissue transfer for reconstructing limb soft tissue defects. Moreover, the SCIP flap is an ideal flap with pleasing aesthetics because the donor-site scar is situated in a well-hidden site. Care must be taken when vein grafts are used to lengthen the flap as flap necrosis rates increase.

Functional Cerebral Venous Anatomy from the Viewpoint of Venous Collaterals Part I, Supratentorial Superficial and Deep Venous System

Abstract Supratentorial veins are divided into superficial and deep venous systems. Most superficial veins drain into the superior sagittal sinus, cavernous sinus, transverse sinus, and inferior sagittal sinuses. Most deep veins drain into the internal cerebral vein, and some drain into the basal vein of Rosenthal, which head toward the great cerebral vein of Galen. The functional anatomy of the supratentorial cerebral veins can be explained by dividing them into (1) veins on the lateral surface of the cerebral hemisphere, (2) the basal vein of Rosenthal system, and (3) the internal cerebral vein system. Many anastomotic channels exist between the superficial venous systems, veins at the base of the brain, and transcerebral veins. To understand and prevent adverse neurointerventional effects, in this study, we review the cerebral venous anatomy from the viewpoint of venous collaterals.

CHRONIC VENOUS INSUFFICIENCY AND TROPHIC ULCERS OF THE LOWER EXTREMITIES

Chronic venous hypertension (CVH) triggers a whole cascade of pathological reactions, the ultimate result of which is gross changes in the trophism of soft tissues of the lower extremities. The main hemodynamic factor leading to hypertension in the superficial venous system and, subsequently, to trophic changes in the lower limb, is blood reflux from deep veins, and it is associated with valve insufficiency at the mouth of the great and small saphenous veins (vertical reflux), as well as incompetency of perforators (horizontal reflux). Moreover, 90% of the latter are localized in the calf region, of which 87% belong to the veins ofthe Cockett I-III zone.

The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction.

Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.

Supercharging DIEP Flaps Using Contralateral Superficial Inferior Epigastric Vein Grafts

Introduction: Venous congestion, even with a patent deep venous anastomosis, can afflict some DIEP (Deep Inferior Epigastric Perforator) flaps and various techniques of superficial venous supercharging have been described, although the indications for its use are not consensual. The main goal of this study is to confirm that superficial venous supercharge of DIEP flaps, utilizing the contralateral Superficial Inferior Epigastric Vein (SIEV) as an interposition vein graft, is feasible and functional. Materials and Methods: We retrospectively reviewed all DIEP flap breast reconstruction patients treated at our institution between June 2016 and December 2017 and that met all the inclusion criteria: Unilateral breast reconstruction with a DIEP flap; flap weighing more than 750 gm; supercharging of the ipsilateral superficial venous system; contralateral SIEV interposition graft; implantable doppler probe in the superficial system for at least 5 days. In the technique described here, the contralateral SIEV graft was harvested and anastomosed to the ipsilateral SIEV, obtaining this way a long vein that easily reaches the recipient vein (distal end of the Internal Mammary Vein - IMV). A Doppler probe was implanted in the superficial system, for at least 5 postoperative days, to monitor the function of this supercharging. We also analyzed the patient’s history, flaps weight, number and perforator rows, recipient vessels, SIEV graft length and diameter and all perioperative complications. Results: Ten patients met all inclusion criteria. They were treated using this technique and analyzed. Two patients had some type of alteration of the Doppler signal and clinical signs of venous congestion. They were surgically revised with success and were analyzed in detail. No total or partial flap failures were found. Clinical fat necrosis was also absent. Conclusion: This technique seems to be feasible, functional and adds an extra length to ipsilateral SIEV to reach a recipient vein. This way, the flap inset is not compromised by a short SIEV. No further significant morbidity is added for SIEV harvest that is in the same operative field, unlike the saphenous or cephalic veins. In selected patients, it could be an alternative supercharging technique.

Role of Jalokaavacharana in the Management of Varicose Veins (Sirajgranthi)- A Case Study

When a vein becomes dilated, elongated and tortuous, the veins is said varicose. The common sight of varicosity are superficial venous system of lower limb effecting either long or short saphenous veins, oesophageal varices, varicosity of haemorrhoidal veins, varicosity of spermatic veins. Generally varicose veins are compared with sirajgranthi according to Ayurveda. Acharya Sushruta had described various types of granthi and its various treatment modalities among them jalaukaavacharana is one of them. Sushruta had given special chapter related to jalauka in which he had described the types, nomenclature, specific qualities of each types of jalauka, their method to apply and detach and how to do vamana of jalauka. Acharya charak also described jalauka as best amongst all anushashtras. Jalaukapossesessheet guna in nature and on the basis of sign and symptoms varicose veins can be correlated with sirajgranthi. In this case study a 36- year old woman of bilateral varicose veins was treated successfully and found symptomatic relief.&#x0D; &#x0D;

Association between the degree of iliac venous outflow obstruction by intravascular ultrasound and lower limb venous reflux

ObjectiveThe present study aims to evaluate the association between the degree of iliac venous outflow obstruction (IVOO) identified by intravascular ultrasound (IVUS) and venous reflux presentation in the lower limbs on duplex ultrasound (DU). MethodsPatients with bilateral chronic venous insufficiency, CEAP (clinical-etiology-anatomy-pathophysiology) C3 to C6, and a visual analog scale score for pain >5 underwent DU for reflux evaluation of the deep venous system (reflux ≥1 second); superficial system, great saphenous vein, and small saphenous vein (reflux ≥0.5 second); and perforator system (reflux ≥0.35 second). All patients underwent IVUS in the iliac venous territory. The area of the impaired venous segments was categorized as obstruction <50% (category 1), 50% to 79% (category 2), and ≥80% (category 3). The venous clinical severity score and reflux multisegment score (RMS) were assessed. ResultsA total of 51 patients (n = 102 limbs; age, 50.53 ± 14.5 years; 6 men) were included. The predominant clinical severity CEAP class was C3 in 54 of 102 limbs (52.9%). The mean VCSS was 14.3 ± 6.7. A severe RMS (≥3) was registered in 63.4% of the limbs. Of the 102 limbs, 51 (50%) presented with category 1, 27 (26.5%) with category 2, and 24 (23.5%) with category 3. Previous deep vein thrombosis (DVT) was associated with critical obstruction (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.29-10.38; P = .015). The superficial and perforator venous systems had no association with the degree of IVOO. Deep venous reflux (DVR) had a significant association with significant IVOO (obstruction ≥50%; OR, 6.44; 95% CI, 2.19-18.93; P = .001) and critical IVOO (obstruction ≥80%; OR, 4.57; 95% CI, 1.70-12.27; P = .003) and a significant linear association with the IVOO degree and reflux in the femoral veins (P < .001) and popliteal vein (P = .008). Significant lesions were significantly more likely to develop in the left limb (OR, 5.76; 95% CI, 2.46-13.50; P < .001). After multivariate analysis, DVR remained a predictor for significant and critical obstruction (P < .003 and P < .012, respectively). Left limb and previous DVT remained as predictors for IVOO of ≥50% and ≥80% (P < .001 and P = .043, respectively). ConclusionsWe found a significant linear association between the degree of IVOO and reflux in the deep venous system on DU. Limbs with DVR, a severe RMS, loss of respiratory variation on DU, and previous DVT were more likely to be affected by IVOO of ≥50%, especially with left leg involvement.

Continuous ex vivo glucose sensing in human physiological fluids using an enzymatic sensor in a vein replica

Managing blood glucose can affect important clinical outcomes during the intraoperative phase of surgery. However, currently available instruments for glucose monitoring during surgery are few and not optimized for the specific application. Here we report an attempt to exploit an enzymatic sensor in a vein replica that could continuously monitor glucose level in an authentic human bloodstream. First, detailed investigations of the superficial venous systems of volunteers were carried out using ocular and palpating examinations, as well as advanced ultrasound measurements. Second, a tubular glucose-sensitive biosensor mimicking a venous system was designed and tested. Almost ideal linear dependence of current output on glucose concentration in phosphate buffer saline was obtained in the range 2.2–22.0 mM, whereas the dependence in human plasma was less linear. Finally, the developed biosensor was investigated in whole blood under homeostatic conditions. A specific correlation was found between the current output and glucose concentration at the initial stage of the biodevice operation. However, with time, blood coagulation during measurements negatively affected the performance of the biodevice. When the experimental results were remodeled to predict the response without the influence of blood coagulation, the sensor output closely followed the blood glucose level.

Bone-based versus soft-tissue free flaps in lower extremity reconstruction

BackgroundMost lower extremity defects and minor bone defect wounds requiring a free flap are treatable with soft-tissue flaps, whereas large bone defect wounds are treated with bone-based flaps. This study aimed to compare bone-based and soft-tissue-free flaps in terms of operative procedures and postoperative complications, including long-term outcomes of lower extremity reconstruction. MethodsThis two-center retrospective cohort study collected data from all lower-extremity reconstructions with free flaps performed between March 2014 and February 2022; the level of evidence is considered to be therapeutic level III. We investigated the operative procedure and postoperative complications classified as being related to either bone-based or soft-tissue flaps. The data were further classified into the trauma and non-trauma groups and the long-term postoperative outcomes of patients who were followed up for ≥12 months were analyzed. ResultsA total of 122 free flaps were included: 29 bone-based flaps (1 scapular and 28 fibular flaps) and 93 soft-tissue flaps (22 muscle-based and 71 fasciocutaneous flaps). There was no significant difference in postoperative complications, including long-term outcomes, between the free flap types, regardless of etiology. Vein grafts were used more often for bone-based flaps than for soft-tissue flaps (20.7% vs. 7.5%; p = 0.045). The donor veins of bone-based flaps were more often anastomosed to superficial veins than were those of soft-tissue flaps (37.9% vs. 10.8%; p < 0.001). ConclusionsUsing bone-based free flaps resulted in no significant differences in postoperative complications, including long-term outcomes, despite involving more complicated operative procedures than soft-tissue flaps. Thus, the use of vein grafts and anastomosis to the superficial venous system of the vascularized fibula graft may help avoid flap-related complications in bone-based free flaps.

Ultrasound Evaluation of Chronic Venous Insufficiency.

Chronic venous insufficiency is a common condition caused by valvular incompetence and/or obstruction of the lower extremity venous system. Chronic venous insufficiency presents in a wide range of clinical presentations, ranging from mild pain or edema to the development of varicose veins and nonhealing venous ulcers. Doppler ultrasound is the preferred imaging modality in the assessment of this condition and provides both anatomical and functional information in a noninvasive, cost-effective, and radiation-free manner. Knowledge of the anatomy and nomenclature, pathophysiology, equipment requisites, scanning protocols, relevant findings, and reporting nuances is essential to the creation of an accurate and clinically actionable report. Evaluation of the superficial and deep venous system for degree and extent of reflux is necessary to establish the diagnosis and to institute appropriate treatment.

Balneotherapy for chronic venous insufficiency.

Balneotherapy for chronic venous insufficiency.

Reconstruction of upper extremity soft tissue defects with free flaps

Amaç: Çeşitli etiyolojik nedenler sonucu ortaya çıkabilen üst ekstremite defektlerinin rekonstrüksiyonu için literatürde pek çok yöntem tanımlanmıştır. Bu yöntemler arasında lokal veya bölgesel flepler oldukça sık kullanılmakta olup çoğu defekt başarılı bir şekilde rekonstrükte edilebilmektedir. Bununla birlikte bazı büyük ve kompleks defektlerde, teknik olarak daha zor olan serbest flep seçenekleri&#x0D; kaçınılmaz olabilmektedir. Çalışmamızda serbest fleplerle üst ekstremite rekonstrüksiyonu hakkındaki tecrübelerimizi sunmayı planladık.&#x0D; Gereç ve Yöntem: 2015 - 2021 yılları arasında 9 hastada (3 Kadın, 6 Erkek) serbest fleplerle üst ekstremite rekonstrüksiyonu uygulandı. Hastaların yaşları 22-68 arasında değişmekteydi. Serbest flep tercihlerimiz arasında 4 hastada anterolateral uyluk flebi, 4 hastada latissimus dorsi serbest flebi ve 1 hastada radial ön kol serbest flebi yer almaktaydı. Hastaların defektleri; 3 hastada el dorsumu, 1&#x0D; hastada amputasyon güdüğü, 2 hastada ön kol ile birlikte el dorsumu ve 3 hastada ön kol ile birlikte dirsekte bulunmaktaydı.&#x0D; Bulgular: Bütün hastalarda alıcı arter olarak radial arter seçildi. Alıcı ven olarak, radial arterin konkomitan veni veya yüzeyel venöz sistem kullanıldı. 6 hastada uç-uca, 3 hastada uç-yan anastomoz yapıldı.1 hastada arteriyel tromboz ve 1 hastada venöz tromboz gözlendi. Vasküler komplikasyon görülen bu hastalarda serbest latissimus dorsi flebi tercih edilmişti. İki hasta da erken dönem kurtarma cerrahisine alınarak anastomoz hatları yenilendi ve flepler kurtarıldı. Diğer hastalarda ek komplikasyon izlenmedi. Klinik serimizde flep kaybı yaşanmadı.&#x0D; Sonuç: Uygun vakalarda, üst ekstremite yumuşak doku rekonstrüksiyonları için serbest flepler güvenle kullanılabilir. Teknik deneyim gerektirmekle beraber, minimal donör saha problemleri nedeniyle perforatör tabanlı serbest fleplerin oldukça avantajlı olduğu ve uygun hastalarda ilk yöntem olarak güvenle seçilebileceği kanaatindeyiz.