Arterialized venous flaps for reconstructing soft-tissue defects of the extremities.

Four cases of soft-tissue defects of the extremities are presented. Each defect was covered by a fasciocutaneous venous free flap in which arterial inflow relied solely on the venous pedicle. India ink injection of the saphenous vein in eight cadaver lower extremities revealed that only the subdermal venous plexus supplies the cutaneous island. Clinically, flaps ranged in size from 4 x 6 cm to 5 x 9 cm. Three flaps survived completely, while one flap lost the cutaneous portion of its skin island. However, the subcutaneous tissue survived. Although free venous fasciocutaneous flaps have a more tenuous blood supply in the immediate postoperative period, this flap can be transferred successfully without the sacrifice of a donor artery.