The Role of Interposition Composite Arteriovenous Bundles in Free Tissue Transfer

Free flaps have become the standard of treatment for complex tissue defects following trauma or oncological resection. At times, there is a lack of available recipient vessels near the defect. Classically, this problem has been circumvented with the use of vein grafts, either as interpositional grafts or arteriovenous (AV) loops. Other solutions include the use of bridging flaps, or, more recently, interpositional composite AV bundles (ICAVB). This is a relatively new technique with few publications in the literature. In this article, we share our experience of 18 successful ICAVB cases and discuss the indications, choice of donor and technical tips for the execution of this technique. Level of Evidence: Level V (Therapeutic).