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(a) In case of insufficient revascularization of the flap, a blocking valve before the flap can be the cause; accordingly, we suggest performing a more distal anastomosis to the same or to a different vein. Otherwise, we suggest switching the arterialized vein with the draining one as an alternative. (b) In case of congestion due to an Artero-Venous (AV) shunt, ligature is recommended; (c) alternatively, a second draining vein can be anastomosed in order to resolve the congestion.
