Arteriovenous Loops for Free Flaps to the Abdomen and Pelvis: Case Reports and Pearls

Arteriovenous (AV) loops formed from the greater saphenous vein and femoral artery can facilitate free tissue transfer to the abdomen or pelvis when adequate recipient vessels are not available. Here, we present the application of this technique in 3 cases where patients had significant abdominal or pelvic defects due to oncological resection or trauma. AV loops were successfully created using a saphenous vein turned up into the femoral artery at the level of the groin. These loops were then tunneled through the groin and cut back to form recipient vessels for anterolateral thigh (ALT) flaps in a single-stage procedure. In all 3 cases, AV loops constructed with this technique served as reliable conduits for free ALT flaps. Only 1 complication occurred. Following a drop in tissue oximetry, 1 patient was taken back to the operating room. A stitch was found to be compressing the pedicle. Following release, no further complications were observed and all patients achieved complete wound healing. In this article, we highlight key surgical techniques to maintain the orientation of the vein during AV loop anastomosis, which prevents kinking. We provide technical insights regarding tunneling the AV loop through the groin without compression, anchoring the pedicle appropriately, and positioning the ALT flap anastomosis. Our success with this technique underscores its potential in facilitating complex pelvic and abdominal reconstruction.