Distally based free flap using retrograde arterial flow

In lower extremity injuries, the major arteries are frequently damaged and the remaining artery may be located in the traumatized zone. Recently, vascular anastomoses to recipient vessels distal to the zone of injuries have been advocated in the lower limb reconstruction and flaps by using retrograde arterial flow are well established in island flaps. Twelve patients with soft-tissue defects below the knee underwent lower extremity reconstruction with distally based free flaps by using retrograde arterial flow. For assessment of retrograde flow, the intraoperative retrograde arterial pressure was quantitated and compared with the systolic blood pressure taken at the same time (n = 6). In this study, suitable candidates had been chosen with pulsatile retrograde flow from the distal cut end of the vessel because patients without pulsatile flow had recorded diastolic and systolic retrograde arterial pressures that were very low. Four different free flaps were used. All flaps were successful. Retrograde flow anastomosis could not interrupt the major blood vessels, which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. In cases in which arteriography demonstrates significant vascular flow interruption within the zone of injury, retrograde arterial anastomosis may also be a candidate.