Algorithmic recipient vessel selection for vessel-depleted lower limbs

Area of Science:

• Microsurgery
• Vascular Surgery
• Reconstructive Surgery

Background:

• Lower limb reconstruction presents challenges in recipient vessel selection.
• Optimal outcomes depend on precise vessel choice based on defect characteristics and local vasculature.

Purpose of the Study:

• To develop and validate an algorithm for selecting recipient vessels in lower limb free flap reconstruction.
• The algorithm considers defect location, size, composition, and lower limb vasculature.

Main Methods:

• Retrospective review of 518 lower limb free flap reconstructions (1983-2022).
• Development of a classification algorithm based on vascular availability.
• Matching patients to appropriate reconstructive techniques.

Main Results:

• Algorithm created four patient groups based on vascular availability.
• Group I (419 patients): Direct anastomosis to suitable flaps.
• Group II (25 patients): Free flap with long pedicle to medial sural artery.
• Group III (21 patients): Vein loop or two free flaps using thigh vessels.
• Group IV (53 patients): Two-stage procedure with a bridge flap for limb defects with no available vessels.

Conclusions:

• The developed algorithm provides a systematic and reproducible method.
• It aids in selecting recipient vessels for microsurgical lower limb reconstruction.