Different Types of Arteriovenous Anastomoses between Femoral Artery and Vein Distal to the Island Groin Flap

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An experimental study was done in rats in which the animals were randomly divided into four groups. Each group included bilateral standard island groin flaps. The right side flap was used as control. On the left side, after elevation of the flap, different types of arteriovenous connections were constructed distal to the pedicle between the femoral artery and vein. The connection type was a type-C (end-to-end) anastomosis in Group 1; a type-X (side-to-side) anastomosis in Group 2; a type-Ta (artery-end-to-vein-side) anastomosis in Group 3; and a type-Tv (vein-end-to-artery-side) anastomosis in Group 4. Flow values in the flaps were measured externally and repeatedly using a laser Doppler flowmeter. Extremity changes, signs of congestive heart failure, flap weights (measured at the end of the study), thrombosis at the anastomosis or distal to it, edema in the flaps, subcutaneous venous stasis, and aneurysm formation in the anastomoses were observed. Histopathologic evaluations were also done. Only the side-to-side anastomosis group showed any aneurysm formation in the distal vein, as well as extremity changes and signs of congestive heart failure in some of the animals. Only the artery-end-to-vein-side group showed distal thromboembolism in some animals. All flaps survived, but there was prominent edema in the flaps of Group 2 and Group 4 animals in decreasing order. All the study flaps demonstrated subcutaneous venous stasis and capsule formation. The authors concluded that although any arteriovenous communication located distal to the pedicle of an island skin flap that connects the arterial to the venous system, bypassing microcirculation, may have some beneficial effects, it is not devoid of some possibly hazardous developments, including edema formation and venous stasis.

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