Lower Leg Reconstruction With Free Tissue Transfer Using Reverse Flow Recipient Vein: A Case Report

Area of Science:

• Reconstructive surgery
• Vascular surgery
• Microsurgery

Background:

• Reverse flow flaps have expanded from distally based flaps to free tissue transfers.
• Retrograde arterial inflow is accepted for recipient vessels, but retrograde venous flow reliability is debated.

Observation:

• A patient with a malignant granular cell tumor of the lower leg required wide excision, necessitating resection of the anterior tibial artery and veins.
• A large skin defect (17 × 7 cm) exposed bone and required reconstruction.
• An anterolateral thigh free flap was used, with anastomosis to the distal anterior tibial artery and vein as retrograde recipient vessels.

Findings:

• The free flap demonstrated successful perfusion without signs of venous insufficiency.
• Complete flap survival and no postoperative complications were achieved.
• The use of the anterior tibial vein in a retrograde fashion was successful for venous outflow.

Implications:

• Retrograde venous flow can be a reliable recipient vein option in free tissue transfers for lower leg reconstruction when antegrade options are compromised.
• This case supports the consideration of retrograde recipient veins to overcome challenges in vascular access for free flap surgery.
• Successful lower leg reconstruction using retrograde venous anastomosis expands reconstructive possibilities in complex cases.