Liability of recipient vessels distal to the zone of injury when used for extremity free flaps.
The selection of recipient vessels distal to an extremity defect can be tantalizing option, offering the potential advantage of rapid accessibility to relatively large vessels that, in turn, would simplify revascularization of any desired microsurgical tissue transfer. However, such a maneuver contradicts the traditional dictum that any microanastomosis should be proximal to the zone of injury. A retrospective review of experiences with free flaps to the extremities corroborated this predilection for proximally-based flaps, which were successful in 115 of 136 cases (84.6 percent). Eleven distally-based flaps were also attempted: four were converted intraoperatively to proximally-based flaps; one was moved to an even more distal site, necessitating an interposition vein graft; and one totally failed. Although six (54.5 percent) distally-based flaps were ultimately successful, the incidence of problems encountered overall negated most benefits, so that this option for recipient vessels would rarely be justified.
Hallock
G G
GG
Division of Plastic Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania 18103, USA.
D005121:Extremities / Q000098:blood supply / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008866:Microsurgery; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000379:methods