Liability of Recipient Vessels Distal to the Zone of Injury When Used for Extremity Free Flaps

ABSTRACT

The selection of recipient vessels distal to an extremity defect can be a tantalizing option, offering the potential advantage of rapid accessibility to relatively large vessels that, in turn, would simplify revascularization of any desired microsurgical tissue transfer. However, such a maneuver contradicts the traditional dictum that any microanastomosis should be proximal to the zone of injury. A retrospective review of experiences with free flaps to the extremities corroborated this predilection for proximally-based flaps, which were successful in 115 of 136 cases (84.6 percent). Eleven distally-based flaps were also attempted: four were converted intraoperatively to proximally-based flaps; one was moved to an even more distal site, necessitating an interposition vein graft; and one totally failed. Although six (54.5 percent) distally-based flaps were ultimately successful, the incidence of problems encountered overall negated most benefits, so that this option for recipient vessels would rarely be justified.