Venous Flap Research Articles

Free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect

To explore the feasibility and effectiveness of free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect. Between July 2016 and October 2020, 9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap. There were 6 boys and 3 girls, with an average age of 6.8 years (range, 4-13 years). The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases. Among them, there were 3 cases of index finger wounds, 3 cases of middle finger wounds, 2 cases of ring finger wounds, and 1 case of little finger wounds. The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm. The time from injury to operation was 1.3-8.6 hours, with an average of 4.8 hours. The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm. After the flaps were inverted, the veins were used to bridge the finger arteries while repairing the wounds. The donor site of the foot was sutured directly in 4 cases, and repaired with full-thickness skin grafts in 5 cases. All flaps survived, and hand wounds healed by first intention; 8 cases of foot donor site wounds healed by first intention, and 1 case had partial necrosis in the marginal area of the skin graft, which healed after dressing change. All 9 children were followed up 3-24 months, with an average of 9 months. The color and texture of the flap were similar to those of the surrounding normal skin, and the protective feeling was restored. The two-point discrimination of the flap was 7-10 mm, with an average of 8 mm. At last follow-up, according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association, the finger function was excellent in 5 cases and good in 4 cases. There was no ulcer formation and scar hyperplasia in the foot donor site, which did not affect walking. The free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children's finger wounds with digital artery defect. It has the advantages of simple flap extraction, thin flap, similar color and texture to the skin of the hand, and concealed donor site.

Management of venous flap insufficiency: the role of low molecular weight heparin in salvage

Flap loss resulting from venous insufficiency is a difficult issue, both with pedicled or free flaps. We examined the efficiency of low molecular weight heparin administration in various forms and dressing methods in venous insufficiency. Forty-five Sprague Dawley rats were included and inferior epigastric artery perforated island flaps were obtained from the abdominal skin of the animals. Nine animals were randomly allocated to each of five experimental groups: sham-control (Group 1), venous occlusion only (Group 2), occlusion with systemic enoxaparin (Group 3), occlusion with systemic enoxaparin + local enoxaparin infusion to the punctiform incisions (Group 4), and occlusion with systemic enoxaparin + local enoxaparin infusion to the punctiform incisions and enoxaparin-impregnated sponge dressing (Group 5). Group 5 had higher flap survival rates than the other groups. Groups 3 and 4 had numerically better vitality than the control group, but the difference was not significant. Low molecular weight heparin administration, with or without punctiform incisions, is not efficient in rescuing flaps with venous insufficiency. Specialised dressing methods are necessary to maintain bleeding.

Effect of hirudin on arterialized venous flap survival in rabbits

Arterialized venous flap (AVF) is limited in clinical application because its survival remains inconsistent and its exact survival mechanism is still unclear. Hirudin is an effective thrombin specific inhibitor, which is isolated from the salivary gland secretions of the leech. Our study evaluated the impact of hirudin on the viability of AVFs in rabbits. Thirty-six rabbits were randomly divided into three groups: sham group (physiological perfusion), control group (AVF), and hirudin group (AVF + hirudin). In hirudin group, 20 antithrombin units (ATU) hirudin (2.5 ml) were injected into each flap. In sham group and control group, the same amount of normal saline was injected into each flap. Status of flap survival, water content, vascular perfusion, histopathology, expression of CD34, VEGF, eNOS and HIF-1α were analyzed in each group. Analysis of oxidative stress was performed by measuring the activity of superoxide dismutase (SOD) and malondialdehyde (MDA). Compared with flaps in sham group with physiological perfusion mode, results of survival rate, perfusion status, SOD activity, expression of CD34, VEGF, and eNOS of AVFs in control group were significantly lower, while water content, MDA level and expression of HIF-1α were higher. The flap condition of AVFs injected with hirudin in hirudin group was improved significantly, and the results were similar to sham group. Our findings revealed that hirudin can effectively improve survival of AVF.

Reconstruction of traumatic hand defects with shunt-restricted arterialised venous flaps — a surgical process flow and our experience

Arterialised venous flaps (AVFs) are a flexible reconstructive option for hand defects with advantages including minimal donor site morbidity, abundant donor sites and relative ease of harvest. However, venous congestion and partial necrosis remain common drawbacks. Shunt restriction is a reported method of optimising the latter and improving flap survival. We illustrate a ‘how-to’ surgical process flow and report our experience with a series of these flaps in the reconstruction of hand defects. Hand defects from 9.4 to 18.8 cm2 (Median 14.1 cm2) within 2 weeks of injury were included in this series. Type III and IV AVFs, with ‘II’ and ‘H’ donor venous patterns, were harvested from the volar forearm. Survival, ischaemia/necrosis, venous congestion and total active motion (TAM) were assessed during follow-up. A total of six shunt-restricted AVFs were performed (2013 to 2017). One flap was lost to efferent venous thrombosis day 10 post-operative secondary to noncompliance and unrelated trauma sequelae. The remainder maintained good perfusion with no partial full-thickness loss, despite anticipated mild–moderate congestion and pre-emptive leeching. TAM at 7 months post-operative or later varied according to original underlying joint involvement. AVFs are a potentially underutilised reconstructive option for hand defects which provide thin, pliable and well-contoured soft tissue whilst minimising donor-site morbidity and hand stiffness. Strategies such as shunt restriction have been shown in previous studies to enhance their reliability and outcomes, avoiding partial thickness necrosis, and may hence broaden the use of AVFs. Level of evidence: Level IV, therapeutic study.

A metabolic investigation of arterialized venous flaps in rabbits using mass spectrometry-based metabolomics.

An arterialized venous flap (AVF) is an ideal choice of flap to repair wounds. However, the survival of these flaps remains the source of some concern. This study used metabolomic analysis to investigate the mechanisms underlying survival in AVF flaps in order to guide the clinical application of these flaps. Thirty-six male Japanese rabbits were randomly divided into a sham group and an AVF group. They were used for histology and hemodynamic investigations. Three days after surgery, tissue samples were analyzed by mass spectroscopy-based metabolomics. The results of the study revealed a reduction in blood flow, infiltration of inflammatory cells, and necrosis of flaps in the AVF group. In addition, notable changes were evident in the levels of several metabolites in the AVF group, including lactic acid, acetoacetic acid, inositol phosphate, arachidonic acid, and other metabolites. Our results indicate that the AVF group experienced changes in several biological pathways, including energy metabolism, cell membrane stability, and inflammatory response. There is a significant metabolic difference between AVFs and physiological flaps. The dysregulation in certain metabolites may be related to the specific hemodynamics and insufficient energy metabolism of the AVFs.

Evaluation of Leech Therapy in Salvage of Congested Flaps: a Series of Nine Cases

Leech therapy or hirudotherapy is a well-recognized option for treatment of venous congestion in plastic and reconstructive surgery. It is clearly documented in our ancient Sanskrit text like ‘Sushruta Samhita’. Recently, hirudotherapy has become an important modality in salvaging venous congested flaps. This prospective study of 1-year period was conducted at L.N. Medical College and J.K. Hospital, Bhopal, Central India. Leech therapy used in a total of nine patients in this study. Out of nine patients, five were males and four were females, with a mean age of 44 years (range 20 and 74 years). Free flaps were employed in two patients and pedicles flap was used in seven. Venous congestion in most of the patient appeared before 24 h. A number of leeches used ranged from 121 to 180 leeches per patient, with a mean of 150.8. The number of days of leeching was from 4 to 8 days, with a mean of 5.8 days. Blood transfusion required was from 1 to 5 units with a mean of 2.5 units. No local or systemic complications were observed in our study. The overall flap survival rate was 77.7% (7/9) with flap loss in two patients. Venous congestion is the most common cause of flap failure. Application of leech therapy is a helpful tool in salvaging the tissue transfer, not otherwise salvageable by surgical means.

Evaluation of Role of Arterialization of Venous Flaps in Abdomen in Rats.

Introduction Reconstruction forms the primary tenet in plastic surgery. Venous flaps are a known option but the survival is limited. Arterialization of venous flap can enhance its survival. While various techniques of arterialization of venous flaps are described, there are very few studies comparing them. Material and methods The current study was conducted among 34 rats weighing 160 to 200 grams. The rats were divided into four groups. Group I—islanded epigastric flap was raised with superficial caudal epigastric vessels as pedicle. Group II—arterialized flow through venous flap was raised with superficial caudal epigastric vein (SCEV) as afferent and lateral thoracic vein as drainage vein. Side-to-side anastomosis was done between femoral artery and vein, lateral to the origin of superficial caudal epigastric artery. Group III—after raising the flap, as in group II, femoral vein was ligated proximal to superficial caudal epigastric vessels. Group IV—an arterialized flow through venous flap was raised with superficial caudal epigastric vein as afferent and lateral thoracic vein as drainage vein. End-to-side anastomosis was done between femoral artery and superficial caudal epigastric vein. Animals that died before completion of the study were excluded. The color changes of flaps were noted. Flap survival was expressed as a percentage of the total flap surface area. The patency of anastomosis was seen on postoperative day 5. Results There was no total flap failure. On statical analysis, the flap survival area on day 5 between Group I and Group IV was not significant ( p value 0.431). The survival area in Group I (78.85 ± 10.54%) was comparable to Group IV (65.71 ± 20.70%). Group II and III had poor results as compared with Group I. In four rats, thrombosis of arteriovenous anastomosis was noted with flap survival area of 30 to 33%. Conclusion It was noted that epigastric venous flaps with end-to-side anastomosis between femoral artery and superficial caudal epigastric vein (group IV) have survival area comparable to islanded flaps.

“TO AND FRO” BLOOD FLOW MATHEMATICAL MODEL IN VENOUS FLAP SURVIVAL

The aim of the research is to determine “to and fro” venous flap blood circulation perfusion ability and flap size survival. Materials and methods: “To and fro” blood circulation mathematical model based on the theory of compressed liquid flow thought the porous medium. Result: Designed mathematical model allows to calculate the viable flap size that depends on pedicle vessel radius, the blood pressure gradient, the blood viscosity, the elastic tissue capacity, the pulse frequency, vessels flap topography and surgical pedicle flap technique. Viable flap width may extent up to 4-6 cm. Conclusions: Only thin skin or fascial flaps, were through venous pedicle with a lot of side branches located under the flap surface and along central flap axis may survive with “to and fro” blood circulation.

Correlation between Venous Thromboembolism Risk and Venous Congestion in Microvascular Reconstruction of the Lower Extremity.

Risk for venous thromboembolism formation and the relationship to postoperative free flap venous congestion and flap failure have not been adequately evaluated in a trauma population. The authors aim to use the Caprini Risk Assessment Model to evaluate the association between venous thromboembolism risk and postoperative flap venous congestion following lower extremity free tissue transfer. A retrospective analysis was conducted of all patients who underwent lower extremity free flap reconstruction of traumatic defects at a single institution between 2007 and 2016. A Wilcoxon rank sum test was used for nonparametric analysis of aggregate Caprini Risk Assessment Model scores and flap outcomes. Flap venous congestion and failure rates as associated with the categorical variables underlying the Caprini Risk Assessment Model were further studied. Logistic regression was used to evaluate each of these outcomes and other flap-related covariates relative to the Caprini Risk Assessment Model categorical variables that had the greatest effect on our patient sample. One hundred twelve patients underwent lower extremity free flap reconstruction. One hundred eight free flaps were analyzed. Eight patients were excluded. The majority of patients were male (75.9 percent) and required reconstruction because of acute trauma (68.1 percent versus 31.9 percent for chronic wounds). There was no statistically significant association found between age, body mass index, or timing of trauma versus venous congestion, flap failure, or other flap-related covariates. In patients with significantly elevated Caprini Risk Assessment Model scores, there was no significant association between venous thromboembolism risk and flap failure following free tissue reconstruction of lower extremities. Risk, III.

Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique.

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein.

Role of Arterial Perfusion in Early Survival of Arterialized Venous Flaps: A Mechanism Study and Clinical Application.

The arterialized venous flap (AVF) is appropriate as a flap for hand and foot resurfacing meet the aesthetic demands in the same time. However, the inconsistency of survival rate limited its popularization in clinical settings. The purpose of this study was to investigate the role played by the caliber and location of the artery. Arterialized venous flaps were designed on the abdomen of New Zealand rabbits, and the animals were randomized into 3 groups and 2 groups in experiment 1 and 2, respectively. In experiment 1, the artery flow was restricted with vascular staplers of different calibers. In experiment 2, the artery was anastomosed with the afferent vein in the center or at the margin of the flap. Blood perfusion state, water content, epidermal metabolite levels, and flap survival status were observed in both experiments. Furthermore, outcomes of 12 patients received AVF to resurface soft tissue defects in the digits, hands, and feet between January 2016 and February 2018 were analyzed. In experiment 1, compared with the control group, groups with restricted artery showed poor results regarding blood perfusion state, water content, epidermal metabolite levels, and flap survival status. In experiment 2, group with the afferent vein in the center of the flap showed better results mentioned previously. All the flaps survived uneventfully in this study. Two flaps partially failed (20% of the flap area) because of insufficient perfusion. Generally, larger caliber and center-located vein helped the survival of AVF. Experimental findings suggested that increased arterial perfusion and center-located vein are beneficial for the survival of AVF. Clinical series proved the findings previously. The problem of inconsistency of AVF can be partially solved by increasing arterial perfusion and dissecting afferent vein into the center of flap, and still, further studies are needed to shed light on the mechanism behind.

Application of Concatenated Arterialized Venous Flaps in Finger Reconstruction.

Application of Concatenated Arterialized Venous Flaps in Finger Reconstruction.

Commentary in Response to "Letter to Editor: Application of Concatenated Arterialized Venous Flaps in Finger Reconstruction".

Lin, Yu-Te MD, MSc, FACS; Loh, Charles Yuen Yung MBBS, MSc, MS, MRCS Author Information

Comparison of therapeutic efficacy between venous flap and the flap with superficial palmar branch of radial artery in reconstruction of the defect of finger with segmental defect of proper digital artery

Objective To compare the effectiveness of venous flap and the flap based on superficial palmar branch of radial artery (SPBRA) in the reconstruction of the defect of finger with segmental defect of proper digital artery. Methods From July, 2014 to March, 2018, 40 patients with soft tissue defects of finger and the proper arteries were treated by the venous flaps (18 cases, group A) and the flaps based on SPBRA (22 cases, group B). The operative time, postoperative 2-PD of the flaps, appearance, patient satisfaction, flaps donor site complications, flaps survival rate and the motion of digital joints were observed and compared by software SPSS 17.0. P<0.05 was considered statistically significant. Results Forty flaps all survived, and the wounds healed primarily. The operative time of group A was (78.89±7.36) min, which was shorter than that of group B (97.27±9.26) min, with statistically significant difference (P 0.05). Conclusion A higher survival rate and satisfactory clinical efficacy can be achieved by the venous flaps and the flap based on SPBRA while the area of defect in hand soft tissue, where there exists a segmental defect of proper arteries, is small. In terms of the recovery of sensing, the first choice is the flap based on SPBRA. In considering of the difficulty in surgical operation, the venous flap is a relatively simple procedure. Key words: Superficial palmar branch of radial artery; Venous flap; Finger injuries; Microsurgical operation

Application of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger

Objective To explore the clinical efficacy of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger. Methods From January 2017 to January 2018, 14 patients with soft tissue defect of finger were treated. The super-thin venous flaps were harvested from the dorsal foot according to the area of finger defects. The wound was repaired by arterialization of veins. The dorsal cutaneous nerve of foot was incised in 4 cases. The donor site was sutured directly. The functional exercises were started after 2 weeks of immobilization. Results All the patients were follow-up for 6 to 12 months, 11 cases survived uneventfully, 2 cases had partial necrosis of skin flaps, and 1 case lost follow-up after 3 months. The partial necrosis of skin flaps healed after dressing change. 10 cases had two-point discrimination of 11 to 13 mm, and 4 cases with nerve in flaps had two-point discrimination of 7 to 9 mm. Conclusion It is simple and satisfactory to repair finger tissue defects with super-thin venous skin flap of dorsal foot. The donor site can be sutured directly and the sensory function can be reconstructed simultaneously with dorsal foot nerve excision. Key words: Finger injuries; Surgical flaps; Arterialized venous; Super-thin skin flap

P6 CFD Modelling of Arterialized Venous Flap

The knowledge about the required quantity of blood to irrigate an angiosome is important on ischemia (disruption on blood perfusion) prediction, diagnosis and treatment. An angiosome (or flap) is an anatomic unity (or flap) of tissue, it is constituted by skin, subcutaneous tissue and muscle, it is irrigated by an artery and drain by specific veins [1]. Since 70’s, flaps have been used on clinical practice for reconstruction of complex anatomical structures. Different model configurations have been created, to find a flap’s model that allows a better flap perfusion. In previous work [2] the four models with an average flap survival area of 76.86% ± 13.67% were tested in 53 male rats: I - conventional model of flap’s blood supply formed by femoral and epigastric arteries; II — Arterialized Venous Flap (AVF) produced by femoral side-to-side anastomosis; III - AVF produced by femoral side-to-side anastomosis and proximal ligation of the femoral vein; IV - AVF produced by terminal lateral anastomosis of the epigastric vein to the femoral artery). The experimental results have shown that the AVFs in group IV represent an optimized model of unconventional perfusion flap. In the present work the Computational Fluid Dynamics (CFD) methods, an ANSYS®-Fluent code, were used for simulating a blood flow and flap perfusion in AVFs of group IV in order to find an optimum geometry for lateral anastomosis of the epigastric vein to the femoral artery with an angle variation from 90,0º to 45,0º. We find that the optimum angle is 86,5º. Three other models, conventional and unconventional, was also tested by CFD, finding that unconventional AVF of group III provides a greater blood flow through the epigastric vein, allowing a better perfusion of the flap.

Venous Flaps for Revascularization and Soft-Tissue Coverage in Traumatic Hand Injuries: A Systematic Review of the Literature.

The use of the venous flap for simultaneous revascularization and coverage of soft tissue defects has been documented in the literature for over 30 years. First described in 1981, Nakayama et al demonstrated that a vein and overlying skin, or a venous flap, may be transposed from one area of the body to another with complete survival of the graft. The aim of this study was to conduct a systematic review of the literature to determine predictors of venous flap survival in traumatic hand injuries. A literature search of PubMed, MEDLINE, and Cochrane Library was performed with emphasis on venous flap use in traumatic hand injuries. MeSH terms included: vein graft, revascularization, venous flow through flap, arterialized venous flap, bypass, replantation, amputation, avulsion, trauma, injury, amputate, finger, hand, and thumb. Forty-three articles were collected that contained data on 626 free venous flaps. Most patients were males (73.9) and injured their right hand (52.3%). The forearm was the most commonly used venous flap donor site (83.6%), and most of the skin paddles were 10 to 25 cm2 (41.1%). Arterial inflow was used in 93.1% of the flaps. Most venous flaps (79.6%) healed without superficial tissue loss or necrosis. Ninety-two (14.7%) flaps had partial loss while 36 (5.8%) flaps did not survive. The use of venous flaps for concomitant revascularization and soft tissue coverage of the hand permits good results with limited morbidity. The overall flap survival rate is nearly 95%. Younger patients whose flaps have arterial inflow and skin paddles of medium size (10-25 cm2) have the best chance for survival.

The experience of the free superficial palmar branch of the radial artery perforator flap application

PurposeThe purpose of this study is to retrospect and summarize clinical efficacy and experience of the free perforator flap base on the superficial palmar branch of the radial artery for tissue defect reconstruction in hand. Method17 patients who underwent tissue defect in hands reconstruction by the free superficial palmar branch of the radial artery (SPBRA) perforator flaps in our department from July 2014 to October 2018 were reviewed. ResultsAll the flaps in our series application were survival uneventful except one, which was necrosis because of venous thrombosis postoperative 5 days, and then the abdominal pedicle flap was executed to recover the defect in second stage. The first dorsal metacarpal artery flap and the arterial venous flap were utilized to cover the defect in one right index finger and one right ring finger due to the absence variation of the SPBRA. 2 cases presented tension vesicle of superficial skin and 1 case occurred venous congestion. All donor sites were closed primarily. The follow-up period means 13.5 months (range, 4–50 months). The static 2 point discrimination test mean 7.53 mm (range, 4–11 mm). All flaps acquire protective feeling at the latest follow-up. The self-assessment of patients: 13 cases in good, 4 cases in fair. ConclusionThe goal of physiological reconstruction and esthetic effect can be achieved for hand tissue defect by the free SPBRA perforator flap, multiple tissues of the flap can be contained according to the defect. Even though the SPBRA is variation, arterial venous flap could be applied thanks to abundant superficial cutaneous veins.

BD-2 and BD-3 increase skin flap survival in a model of ischemia and Pseudomonas aeruginosa infection

The main aim of this work was to study the usefulness of human β-defensins 2 (BD-2) and 3 (BD-3), which are part of the innate immune system, in the treatment of infected ischemic skin flaps. We investigated the effect of transducing rat ischemic skin flaps with lentiviral vectors encoding human BD-2, BD-3, or both BD-2 and BD-3, to increase flap survival in the context of a P. aeruginosa infection associated with a foreign body. The secondary endpoints assessed were: bacterial counts, and biofilm formation on the surface of the foreign body. A local ischemic environment was created by producing arterialized venous flaps in the left epigastric region of rats. Flaps were intentionally infected by placing underneath them two catheters with 105 CFU of P. aeruginosa before the surgical wounds were hermetically closed. Flap biopsies were performed 3 and 7 days post-operatively, and the specimens submitted to immunohistochemical analysis for BD-2 and BD-3, as well as to bacterial quantification. Subsequently, the catheter segments were analyzed with scanning electron microscopy (SEM). Flaps transduced with BD-2 and BD-3 showed expression of these defensins and presented increased flap survival. Rats transduced with BD-3 presented a net reduction in the number of P. aeruginosa on the surface of the foreign body and lesser biofilm formation.

Repair of soft tissue defect of fingers with modified arterialized venous flap

To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers. Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft. All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm). Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.