Use of flap based on posterior tibial artery for free transfer

Free flap transfer can be a challenge because of the risk of anastomotic failure, especially in microvascular tissue transfers. Although free medial crural flap based on posterior tibial artery has many advantages and a high survival rate, the flap is now performed with decreasing frequency for transfer because of the sacrifice of one of the main arteries in the calf. To overcome this disadvantage, arterial reconstruction has been developed and is already in use in clinical cases. The authors describe a case of the "half-half' technique being performed. The donor artery was reconstructed in a simple way with a little cost. Twelve patients underwent this type of flap transfer and subsequent arterial reconstruction. All flaps survived. In no case was a subsequent anastomosis/thrombosis operation required. Donor-site morbidities were negligible. The free medial crural flap can be used reliably and successfully with advantages of large vessel diameter and preservation of the major artery trunk.