Local advancement flap for coverage of vascular anastomoses

Outflow anastomoses of infrainguinal distal bypass grafts are often located beneath compromised skin wounds, which may dehisce leading to exposure of the distal graft anastomosis. Debridement of necrotic skin and flap coverage of the graft are standard remedial procedures for this complication. Very distal sites in the lower extremity offer few local muscle flap coverage options and may require free tissue transfer. We describe a simple local advancement flap technique that we have found to be successful without the need to perform free tissue transfer in the majority of cases.