LIABILITY OF RECIPIENT VESSELS DISTAL TO THE ZONE OF INJURY WHEN USEDFOR EXTREMITY FREE FLAPS

The selection of recipient vessels distal to an extremity defect can b e a tantalizing option, offering the potential advantage of rapid acce ssibility to relatively large vessels that, in turn, would simplify re vascularization of any desired microsurgical tissue transfer. However, such a maneuver contradicts the traditional dictum that any microanas tomosis should be proximal to the zone of injury. A retrospective revi ew 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 at tempted: four were converted intraoperatively to proximally-based flap s; one was moved to an even more distal site, necessitating an interpo sition vein graft, and one totally failed. Although six (54.5 percent) distally-based flaps were ultimately successful, the incidence of pro blems encountered overall negated most benefits, so that this option f or recipient vessels would rarely be justified.