Reconstruction of the traumatized leg: use of distally based free flaps

Microvascular free-tissue transfer is often employed to achieve limb salvage in traumatic leg wounds. Previous experience has shown that one cause of flap failure is placement of the microvascular anastomoses within the zone of injury and subsequent thrombosis. This observation has prompted surgeons to perform anastomoses on the proximal uninjured recipient vessels. However, access to the vessels distal to the injury site is often technically easier. An assessment was made of 23 free flaps used for leg reconstruction to evaluate the success of performing microvascular anastomoses distal to the zone of injury. Twenty-one flaps with distal anastomoses were successful (91 percent). Distally based free-flap reconstruction provides an acceptable alternative to the commonly employed proximal approach.