[How long is a musculocutaneous microvascular transplant flap dependent on its vascular pedicle?]

Two cases of open fractures of the lower leg with microvascular flap reconstruction for soft-tissue coverage illustrate the time span necessary for neovascularisation of the flap. In the first case, the supplying artery of the flap had to be ligated due to a septic aneurysm 17 days after operation. Because of sufficient blood circulation between the flap margin and the surrounding tissue, there was no ischemic damage to the flap. A similar observation was made in a second case, where more than one year postoperatively, venous congestion was managed with leeches. Careful consideration must be given to incisions of these microvascular flaps prior to any further surgical procedure, particularly if the traumatised region is badly vascularised and the flap consists only of a split thickness skin grafted muscle.