Venae comitantes as a source of vein grafts

The use of vein grafts is commonplace and often essential in microvascular surgery. Typically, these are obtained from the superficial venous system, and most commonly from the lower extremity using branches or segments of the greater or lesser saphenous veins. Unfortunately, on rare occasions these usual donor sites may have been totally exploited. This potential dilemma can be solved by using the deep venae comitantes as autogenous vein grafts. By way of example, these can be venae comitantes of the free flap itself, or via salvage of parts using a vena comitans that accompanied a major limb source vessel.