Clinical experiences with distally based free flap using retrograde arterial frow

Minn, Kyung Won; Lee, Min Goo

Abstract

Microvascular surgery can provide the necessary soft tissue coverage from the remote donor areas by free flap transfer into the defect. Correct selection of the appropriate recipient vessels is difficult and remains the most important factor in successful free flap transfer. Recently, vascular anastomosis to recipient vessels distal to the zone of injury has been advocated and retrograde for flaps are well established in island flaps. Purpose of this study is to report our clinical experiences with lower extremity reconstruction in 9 patients. 9 patients with soft tissue defect below the knee underwent lower extremity reconstruction with distally based free flaps using retrograde arterial flow. For assessment of the retrograde flow, intraoperative retrograde arterial pressure was quantified and compared with systolic blood pressure taken at the same time. Suitable candidates had ben chosen with pulsatile retrograde flow and a diastolic retrograde arterial pressure of 60 mmHg. Three different free flaps were used. All flaps were successful. Retrograde flow anastomosis could not interrupting the major blood vessels which were essential for survival of the distal limb, the compromise of fracture or wound healing might be prevented. In cases wherein arteriography demostrates significant vascular flow interruption within the zone of injury, those are also candidate for retrograde arterial anastomosis.