Absent neovascularization in a lower extremity free flap: a case report

Area of Science:

• Microsurgery
• Vascular surgery
• Reconstructive surgery

Background:

• Free tissue transfer is a common reconstructive technique.
• The lower extremity presents unique challenges for vascularized tissue transfer.
• Collateral circulation is crucial for flap survival if the primary vascular pedicle is compromised.

Observation:

• A patient who underwent free tissue transfer to the lower leg experienced a delayed amputation.
• Angiographic evaluation of the amputated limb and flap was performed post-amputation.
• The free flap showed no vascular injection from the surrounding tissues after pedicle clamping.

Findings:

• The lower extremity free flap did not develop significant collateral circulation from surrounding tissues.
• Unlike head and neck free flaps, lower extremity flaps appear to lack robust collateralization.
• Angiography confirmed the absence of vascular connections between the flap and the host limb.

Implications:

• Sacrificing the vascular pedicle of lower extremity free flaps requires extreme caution.
• Surgeons must consider the limited potential for collateral circulation in these cases.
• This finding may influence future surgical planning and patient selection for lower extremity free tissue transfers.