The physiology, microcirculation and clinical application of the shunt-restricted arterialized venous flaps for the reconstruction of digital defects

Reconstruction of digital defects using the venous flap offer several advantages but remained unpopular owing to levels of venous congestion rates. We performed animal studies to test the hypothesis that an arterio-venous shunt increases pressure for peripheral flap perfusion and decreases venous congestion. Using an abdominal adipofascial flap model in six male Sprague-Dawley rats, microcirculation was modified as follows: type I - arterial flap; type II - flow-through arterio-venous flap (AVF); and type III - shunt-restricted AVF. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type I flaps, blood flow was observed to be unidirectional in both arterioles and venules. In type II flaps, blood flow oscillated without a dominant direction and came to a standstill. In type III flaps, blood flowed proximally in a reverse direction whereas distally, flow was similar to type I flaps. In a clinical series, 21 patients received a total of 22 shunt-restricted AVFs. All 22 clinical flaps survived; four flaps suffered epidermolysis but recovered without full thickness loss.