Increasing the vascular pedicle length in a free flap using a two-stage preliminary ectopic transfer

The length of the vascular pedicle is critically important in the use and safety of a free flap. A lengthening of the artery and vein, until now, has been achieved through the use of either an autologous vein interposition graft or an arteriovenous loop. In such patients, the risk is nevertheless increased and does so proportionally to the increasing length of the venous interposition. We present a 30-year-old male electrician who had lost his left forearm and most of his right ulna after high-voltage electrical trauma. Lengthening of the vascular pedicle of a free fibula flap was achieved by anastomosis to the thoracodorsal vessels for 4 weeks. After this time, the flap was raised again together with the pedicle of the latissimus dorsi and used safely for reconstruction of the ulnar defect. Postoperative recovery after both operations was uneventful and the aim of reconstruction fully realized. In our opinion, this procedure provides an interesting alternative in patients in whom the length of the vascular pedicle is crucial but the designated flap has only a short pedicle.