ANATOMY OF VEINS OF DONOR FLAPS AND THE PROCESS OF VENOUS THROMBOSIS

In this work, for the first time from the standpoint of the angiosomal theory of the structure of the human body, an attempt was made to analyze the causes of venous thrombosis in the vascular pedicle of free flaps. There were four main reasons: 1) planning and lifting of the flap without taking into account the boundaries of the venosomes and the peculiarities of the venous outflow from the skin-fascial and musculocutaneous free flaps (the number of venous legs); 2) getting into the composition of the flaps except for the main venosome, which are drained through the commiting veins, another two or three adjacent venosomes; 3) areas of adjacent (marginal) venosomes can be drained into the main venosome through oscillating (valveless) veins, subject to careful hemostasis of the wound surface of the flap; 4) establishment of venous drainage from free skin - fascial flaps without taking into account the priority inclusion of the superficial venous trunk located in the thickness of the subcutaneous fatty tissue; saphenous (visible) veins on the territory of the skinfascial have nothing to do with the drainage of the flap tissue. Anatomically favorable musculocutaneous axial flaps are flaps based on type A muscle, which have a common venous system with the cut out subcutaneous area. All other flaps are “problematic” from the point of view of venous thrombosis after reperfusion.

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