Use of vacuum therapy in a huge arterialized venous flap to reconstruct a complete avulsion of a thumb

Arterialized venous flaps are normally raised from the anterior and distal third of the forearm by integration of a venous pathway. Basically, they are composed of skin, subcutaneous tissue, and subdermal venous plexus. Following transposition to the recipient site one vein is linked to a nourishing artery while the other veins are connected to one or more regional veins. The atypical blood perfusion and the delayed opening of intervenous shunts may result in edema, epidermolysis, or even some degree of skin necrosis that disappear during subsequent treatment. We report the salvage of an atypically raised oversized arterialized venous flap for total soft tissue reconstruction in a complete avulsion of a thumb. By applying V.A.C. therapy atypical perfusion and early intervenous shunt formation was treated successfully, resulting in stable healing and survival of the flap.