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Venous Free Flap with Interposition Bypass Graft for Arteriovenous Fistula Preservation: A Case Report
Journal article   Open access

Venous Free Flap with Interposition Bypass Graft for Arteriovenous Fistula Preservation: A Case Report

Cyril Awaida, Marion Aribert, Natalie Weger, Kendall Keck and Andrei Odobescu
Archives of plastic surgery, Vol.50(6), pp.568-572
2023
DOI: 10.1055/a-2122-6029
PMCID: PMC10736209
PMID: 38143846
url
https://doi.org/10.1055/a-2122-6029View
Published (Version of record) Open Access

Abstract

Cutaneous squamous cell carcinoma (CSCC) overlying an arteriovenous fistula (AVF) is rare and presents unique challenges. This case report describes a method of fistula preservation after CSCC excision using a flow-through venous free flap. The saphenous vein of the venous flap was used as flow-through segment for AVF preservation. The flap was inserted along the dorsal aspect of the forearm wound and microvascular anastomosis of the arterial inflow was completed using a vein just proximal to the radiocephalic fistula anastomosis. Venous outflow was established by creating an end-to-end vascular anastomosis between the cephalic vein and the greater saphenous vein. A separate subcutaneous vein was used to provide a low-pressure outflow for the flap to avoid congestion. This case demonstrates an option for AVF preservation that has not been previously described. It also highlights the importance of a multidisciplinary approach for the safe treatment of CSCCs overlying AVFs.
venous free flap saphenous vein arteriovenous fistula squamous cell carcinoma

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