Anterior Tibial Vessel Turnover as an Alternative Recipient Strategy in Lower Extremity Free Flap Reconstruction

Background/Objectives: Reconstruction of complex lower extremity soft tissue defects remains challenging, particularly in the proximal and middle tibial regions, including the knee, where suitable recipient vessels are often limited due to prior trauma, infection, or surgical intervention. This study aimed to evaluate the feasibility and clinical applicability of anterior tibial vessel turnover as an alternative recipient vessel strategy in free flap reconstruction. Methods: A retrospective review was conducted of seven patients who underwent free flap reconstruction using anterior tibial vessel turnover as the recipient vessel between 2019 and 2024. Preoperative imaging was performed to assess vascular status and collateral circulation. Clinical data, including patient demographics, defect characteristics, flap parameters, and postoperative outcomes, were analyzed. Results: The mean patient age was 62.7 years (range, 38-86 years). Defects were primarily located in the proximal and middle tibial regions and were associated with trauma, postoperative infection, chronic osteomyelitis, or burn injury. The mean flap size was 137.4 cm² (range, 49.5-280 cm²). All flaps survived, resulting in a flap survival rate of 100%, with no cases of total flap loss or re-exploration due to vascular compromise. One patient experienced partial flap loss, while no other flap-related complications were observed. Most patients achieved stable wound coverage and favorable functional recovery. Conclusions: Anterior tibial vessel turnover may serve as an alternative recipient vessel strategy for selected cases of complex lower extremity free flap reconstruction. This technique enables microvascular anastomosis in a more superficial and accessible field and expands reconstructive options in cases with compromised recipient vessels.