Methods for providing vascularized tissue protection of microanastomoses

Perianastomotic thrombosis following free tissue transfer must be systematically prevented if even routine successes are to be expected. One possible culprit that must be considered is the method of soft tissue closure around the recipient site pedicle that frequently poses a challenge to avoid tension and the resultant compression that may then predispose to such thrombosis. One hundred sixteen consecutive free tissue transfers from 1982 to 1990 were analyzed; simple local soft tissue manipulations to provide adequate coverage were satisfactory in 67% of cases. Local flaps (5%) or extensions of the free flap itself (28%) as a source of vascularized tissues were necessary specifically to avoid this risk for the remainder. Ninety-seven percent of these latter flap alterations were required for the extremities where a paucity of local tissues (as would be expected) most frequently precluded local techniques. An appreciation of this seldom discussed but ubiquitous concern for coverage of the zone of microanastomoses to decrease the risk of thrombosis by intentional inclusion of vascularized tissues should serve to eliminate morbidity further in these complex procedures.