FREE-FLAP DISTAL ARTERIOVENOUS-FISTULA - WHEN TO CLOSE IT

A distal arteriovenous fistula was created secondarily in an innervate d radial forearm Free flap, to salvage the neophallus in three female- to-male transsexuals. This resulted in permanent edema and an arterial thrill in the neophallus. The arteriovenous fistulas were closed afte r 6 weeks to 20 months. Acute endothelial damage with risk of thrombos is, due to ischemia and exposure to arterial blood pressure, may be ex pected to have been repaired 4 to 6 weeks after arterialization of the veins. intimal thickening will have started by then, but a subsequent decrease in vascular luminal diameter may still be expected to be rev ersible. The authors conclude that ligation of the distal arteriovenou s fistula may safely be performed some 6 weeks after the salvage proce dure.