[Free forearm flap as a possibility for simultaneous reconstruction of damaged peripheral circulation and skin]

The free forearm flap has become an accepted procedure for cover of defects in the lower leg due to osteitis. Because the diameter of the donor and recipient artery is equal, end-to-side anastomosis is not without problems and in such cases end-to-end anastomosis is preferred. However, if one or more arteries of the lower leg are absent it may be dangerous to do an end-to-end anastomosis because of the further disturbance of circulation. A new method is shown in which the flap vessels act as an arterial and venous bypass, which improves the circulation in the lower leg, while still perfusing the flap. In 18 free forearm flaps to the lower leg, arterial bypass was performed seven times and venous bypass in three cases. One case is demonstrated.