title: Extending the limits of the anterior tibial artery as the recipient vessel for around the knee and proximal lower extremity defect reconstruction using the free anterolateral thigh and gracilis flap.
abstract: OBJECTIVE
  The aim is to describe a technique with orthograde dissection of the anterior tibial artery (ATA) used as the recipient vessel for the end-to-end (ETE) anastomosis in defect reconstruction around the knee and for proximal/middle third leg defects with free anterolateral thigh (ALT) and gracilis flaps.
  
  
  METHODS
  Between March 2009 and May 2014, 22 patients undergoing lower extremity reconstruction were evaluated. Of those, 4 patients were included. The locations of injury were 3 defects around the knee and 1 defect at the proximal and middle third of the lower leg (mean defect size 18 x 8.5 cm and a range of 17-20 x 5-10 cm). There were 2 cases after trauma and 2 cases with infection. Two free gracilis and 2 free ALT flaps were performed of equal size to the defects. The mean flap pedicle length was 11 cm (range of 7-16 cm) and the mean length of the mobilized recipient vessels was 10.5 cm (range of 6-14 cm).
  
  
  RESULTS
  One flap loss (ALT) occurred, requiring a salvage procedure with a latissimus dorsi flap, whereas wound dehiscence at the donor site and a hematoma below the ALT flap was observed in 2 cases, requiring small revision. After a mean follow-up of 52 months (range of 38-87 months), there was stable soft tissue coverage in all patients.
  
  
  CONCLUSIONS
  By orthograde dissection of the ATA, an adequate vessel length and size may be achieved, improving arc of rotation to successfully cover more distant defects.
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.
authors.forename: Mathias
authors.identifier: http://orcid.org/0000-0001-6593-9690
authors.initials: M
authors.lastname: Tremp
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Kappos
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.
authors.forename: Carlo M
authors.initials: CM
authors.lastname: Oranges
authors.affiliation: Department of Plastic, Reconstructive, and Hand Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Pietro G
authors.initials: PG
authors.lastname: di Summa
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Schaefer
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Wettstein
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, Basel, 4031, Switzerland.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D000071976:Gracilis Muscle / Q000637:transplantation*; D006801:Humans; D007717:Knee / Q000601:surgery*; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013848:Thigh; D016909:Tibial Arteries / Q000601:surgery*; D016896:Treatment Outcome