Creation of free flaps by arterialization of the venous system.

We attempted to provide free flaps with nutrient circulation by retrograde venous circulation through microsurgically created arteriovenous (AV) fistulas. We used the rabbit auricle as the animal model because of its accessible central and marginal veins. We created four experimental groups to (1) determine flap survival without blood supply, (2) establish efficacy of microvascular anastomosis, (3) test an end-to-end AV fistula, and (4) test an end-to-side fistula that was converted after one week to an end-to-end version. The nutrient blood supply in two groups existed only as retrograde venous perfusion. We found that retrograde venous perfusion alone was sufficient for flap survival, which equaled or exceeded that achieved with conventional microvascular flap reimplantation. This experiment suggests cutaneous free flaps can be created any place on the body wherein an AV fistula can be developed.