title: Flow-through anastomosis for both the artery and vein in leg free flap transfer.
abstract: OBJECTIVE
  Free flap transfer is an essential part of limb-sparing surgery for leg sarcoma; however, this procedure is associated with a high failure rate. The aim of this study was to identify factors that contribute to microvascular compromise and flap failure for leg free flap transfer, while focusing on anastomotic techniques (end-to-end, end-to-side, and flow-through anastomoses).
  
  
  METHODS
  Data from 56 consecutive patients who underwent leg free flap transfer after oncologic resection were retrospectively reviewed. Of these patients, flow-through anastomosis was performed with the artery in 29 and the vein in 24, whereas conventional techniques were performed in others. The variables contributing to microvascular compromise and flap failure were statistically analyzed.
  
  
  RESULTS
  Venous thrombosis (four patients, 7.1%) was more frequent than arterial thrombosis (one patient, 1.8%) and (4 patients, 7.1%) resulted in flap loss. All anastomotic failures occurred in end-to-end anastomoses. All flow-through anastomoses achieved patency both for the artery and vein. No anastomotic failure or flap loss occurred in 22 flaps which were transferred with flow-through anastomosis for both the artery and vein. Flow-through venous anastomosis tended to have a lower rate of microvascular compromise and flap loss than conventional techniques (P = 0.13 and 0.25, respectively).
  
  
  CONCLUSIONS
  The key to successful leg free flap transfer is to prevent venous failure; thus, flow-through venous anastomosis may be a breakthrough solution. Preferential use of flow-through anastomosis for both the artery and vein can provide predictable results in leg free flap transfer.
authors: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, Japan.
authors: Masahide
authors: M
authors: Fujiki
authors: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, Japan.
authors: Shimpei
authors: S
authors: Miyamoto
authors: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.
authors: Minoru
authors: M
authors: Sakuraba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult