Objective: The objective of this study is to evaluate the role of venous return on venous congestion and flap survival of the arterialized venous flaps (AVFs). Materials and Methods: A 10×8-cm skin flap was designed symmetrically in the rabbit abdomen. Four groups were included: the conventional arterial perfusion flap as the control group and 3 experimental groups. The experimental groups I, II, and III were designed based on the number of drainage veins (1 drainage vein for experimental group I, 2 for group II, and 3 for group III). The thoracoepigastric arteries and veins and 1 femoral artery were used as vascular sources. Levels of epidermal metabolite, water content, status of vascular perfusion, and flap viability in each group were observed and analyzed. Results: In contrast to the control group, significant venous congestion assessed by water content was noted in all the 3 experimental groups and the most severe one was found in the experimental group I, while no statistical difference was observed between the experimental groups II and III. Similar results regarding blood perfusion state, epidermal metabolite levels, and flap survival status were obtained among the 3 experimental groups. Conclusions: Venous return is vital in the survival of AVFs, but the problem of venous congestion can only be partially solved by increasing the number of draining veins. Further studies are warranted to gain insight into this complicated issue.
