Re-use of the recipient vessels of a microvascular transplant

Three cases are described in which a second microvascular free flap, transplanted after a delay of several months, was provided perfusion by re-using the recipient vessels of the first flap in end-to-end fashion. In each patient healing of the second flap was uneventful, and both transplants continue to survive. Prior to harvesting the second transplant, a careful intraoperative examination was performed in which the vascularity of the original transplant was assessed. In each case, recipient vessel re-use represented the least risky of several options. The results of the present series suggest that vascularization from the transplant bed or surrounding tissues proceeds despite the fact that, initially, the only source of blood for the free flap flows through a single axial vessel. This single vessel can therefore be divided without loss of the transplant as long as the transplant bed has already provided vascularization to the flap. In our opinion, the timing of the second procedure and the quality of the transplant bed are the key factors in the survival of the transplants.