Publication:

Using recipient vessels distal to the zone of injury in free flaps for lower limb injuries

This is a retrospective study of free flaps done in injuries of the proximal leg where the microvascular anastomosis was done using recipient vessels “distal” to the defect. 4 of the 5 patients had compound fractures of the upper-middle third of the leg, 1 of the distal third of the femur and 1 patient had a post traumatic unstable leg scar. 3 of the cases were acute, 2 were subacute and 1 was chronic. The anterior tibial and posterior tibial vessels were used in 2 and 4 cases respectively; both the venous and arterial anastomoses were antegraded. The latissimus dorsi was used as the donor flap. There were no flap failures. During the same period there were 34 free flaps for similar defects in the upper third leg or the lower third of thigh, that were done using conventional anastomosis with vessels “proximal” to the defect. The authors review the existing literature and define the indications for safely using a “distally” based micro-anastomosis in compound leg injuries.